NPIMap

Organization Active NPI

Family Practice Clinic of Booneville, Inc.

  • Rural Health Clinic/Center
  • Booneville, KY
National Provider Identifier
1326152109
Registry record updated Dec 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAMILY PRACTICE CLINIC OF BOONEVILLE, INC.
Practice address
200 Mulberry St
Suite a
Booneville, KY 41314-7505
Phone
(606) 593-6023
Fax
(606) 593-6087
NPI assigned
Aug 18, 2006
Last updated
Dec 22, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kim Cox, APRNNPI 1326131434
Title
Owner Operator
Phone
(606) 593-6023

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

200 Mulberry St
Suite a
Booneville, KY 41314-7505

Mailing address

PO Box 737
200 Mulberry Street, Suite a
Booneville, KY 41314-0737
Phone (606) 593-6023

Other identifiers 1

IdentifierTypeStateIssuer
7100159610MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20021210000025 KY Part A Provider - Rural Health Clinic 6406764612 Practice locations: Booneville, KY
O20040327000248 KY Part B Supplier - Clinic/Group Practice 6406764612 Receives reassigned benefits from 41 practitioners
Practice locations: Booneville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326152109. Details of each certification follow.

Rural health clinic certification: CCN 183898

Legal name
FAMILY PRACTICE CLINIC OF BOONEVILLE, INC.
Doing business as
N/A
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 13, 2003
Last certification
Oct 4, 2017
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Apr 9, 2001 in KY
Enrollment address
200 Mulberry St
Ste a
Booneville, KY 41314-7505

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2090598Family Practice Clinic of Booneville Inc200 Mulberry Street, Ste B, Booneville, KY 41314AccreditationMar 24, 2028
18D2289659Family Practice Clinic of Booneville, Inc200 Mulberry St, Ste a, Booneville, KY 41314Certificate of waiverSep 12, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/3044/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kim Aprn Cox Individual 5% Or Greater Direct Ownership Interest Dec 9, 2009
Corporate Officer Dec 9, 2009
Corporate Director Dec 9, 2009
W-2 Managing Employee Dec 9, 2009
Operational/Managerial Control Dec 9, 2009

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Kim B Cox, APRN
    • Psychiatric/Mental Health Nurse Practitioner
    • Booneville, KY
    • NPI 1326131434

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 47

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450742400000",
    "number": "1326152109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 737",
            "address_2": "200 MULBERRY STREET, SUITE A",
            "city": "BOONEVILLE",
            "state": "KY",
            "postal_code": "413140737",
            "telephone_number": "606-593-6023",
            "fax_number": "606-593-6087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MULBERRY ST",
            "address_2": "SUITE A",
            "city": "BOONEVILLE",
            "state": "KY",
            "postal_code": "413147505",
            "telephone_number": "606-593-6023",
            "fax_number": "606-593-6087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE CLINIC OF BOONEVILLE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2015-12-22",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "OWNER OPERATOR",
        "authorized_official_telephone_number": "606-593-6023",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100159610",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Booneville, KY

Sources for this page

Verify at the official NPI Registry.