NPIMap

Organization Active NPI

Mt. Sterling Pediatrics PSC

  • Rural Health Clinic/Center
  • Mt Sterling, KY
National Provider Identifier
1356939235
Registry record updated Aug 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MT. STERLING PEDIATRICS PSC
Practice address
401 Commerce Cir
Mt Sterling, KY 40353-7815
Phone
(859) 498-5243
Fax
(859) 498-5396
NPI assigned
Jan 6, 2021
Last updated
Aug 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2023

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

Authorized official

Name
Brandy Bromagen Fouch, MDNPI 1417967753
Title
Owner
Phone
(859) 498-5243

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

401 Commerce Cir
Mt Sterling, KY 40353-7815

Mailing address

401 Commerce Cir
Mt Sterling, KY 40353-7815
Phone (859) 498-5243

Other identifiers 1

IdentifierTypeStateIssuer
7100738420MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210112000788 KY Part A Provider - Rural Health Clinic 5193138154 Practice locations: Mt Sterling, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356939235. Details of each certification follow.

Rural health clinic certification: CCN B03836

Legal name
MT STERLING PEDIATRICS PSC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 9, 2021
Last certification
Mar 6, 2024
Ownership / control type
1C
Organization structure
CorporationProprietary
Incorporated
Dec 18, 2008 in KY
Enrollment address
401 Commerce Cir
Mt Sterling, KY 40353-7815

National Provider Directory

National Provider Directory
Tax ID family
Mt Sterling Pediatrics3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

401 Commerce Cir
Mt Sterling, KY 40353
Phone (859) 498-5243

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
Brandy B Fouch Individual 5% Or Greater Direct Ownership Interest Dec 18, 2008 100%
Corporate OfficerPresident Jan 6, 2021 100%
W-2 Managing EmployeePresident Jan 6, 2021 100%

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1609891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691020800000",
    "number": "1356939235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 COMMERCE CIR",
            "city": "MT STERLING",
            "state": "KY",
            "postal_code": "403537815",
            "telephone_number": "859-498-5243",
            "fax_number": "859-498-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 COMMERCE CIR",
            "city": "MT STERLING",
            "state": "KY",
            "postal_code": "403537815",
            "telephone_number": "859-498-5243",
            "fax_number": "859-498-5396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. STERLING PEDIATRICS PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-06",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A",
        "authorized_official_last_name": "FOUCH",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_middle_name": "BROMAGEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "859-498-5243",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100738420",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Sterling, KY

Sources for this page

Verify at the official NPI Registry.