NPIMap

Organization Active NPI

Williamsburg Family Medicine Center

  • Rural Health Clinic/Center
  • Williamsburg, KY
National Provider Identifier
1376689620
Registry record updated Dec 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
900065 Issued in KY
Legal business name
WILLIAMSBURG FAMILY MEDICINE CENTER
Practice address
475 N Highway 25 W Ste 100
Williamsburg, KY 40769-1576
Phone
(606) 549-2933
NPI assigned
Jan 30, 2007
Last updated
Dec 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2023

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

Authorized official

Name
Christy Timmins
Title
CPC
Phone
(423) 784-0269

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 900065 KY Primary

Addresses

Primary practice location

475 N Highway 25 W Ste 100
Williamsburg, KY 40769-1576

Mailing address

PO Box 247
Jellico, TN 37762-0247
Phone (423) 784-0269

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040311000399 KY Part A Provider - Rural Health Clinic 2365331188 Practice locations: Williamsburg, KY
O20041108001285 KY Part B Supplier - Clinic/Group Practice 2365331188 Receives reassigned benefits from 8 practitioners
Practice locations: Williamsburg, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376689620. Details of each certification follow.

Rural health clinic certification: CCN 183832

Legal name
WILLIAMSBURG FAMILY MEDICINE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 12, 1996
Last certification
Oct 2, 2017
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
May 7, 1999 in KY
Enrollment address
475 Hwy 25 WN
Suite 100
Williamsburg, KY 40769-1576

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
18D0323826Williamsburg Family Medicine Center475 Highway 25W, Williamsburg, KY 40769Certificate of waiverApr 19, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24026/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Darryl John Wilkens Individual 5% Or Greater Direct Ownership InterestPresident Dec 27, 2021 33%
W-2 Managing Employee Dec 27, 2021
Stephen Boone Individual Corporate OfficerCeo Jan 1, 2013
W-2 Managing EmployeeVice President, Ceo Dec 27, 2021
Todd H. Wilkens Individual 5% Or Greater Direct Ownership Interest Dec 21, 2021 33%
Gregory C. Wilkens Individual 5% Or Greater Direct Ownership Interest Dec 21, 2021

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 12

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": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702598400000",
    "number": "1376689620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377620247",
            "telephone_number": "423-784-0269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 N HIGHWAY 25 W STE 100",
            "city": "WILLIAMSBURG",
            "state": "KY",
            "postal_code": "407691576",
            "telephone_number": "606-549-2933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSBURG FAMILY MEDICINE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A",
        "authorized_official_last_name": "TIMMINS",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "CPC",
        "authorized_official_telephone_number": "423-784-0269"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsburg, KY

Sources for this page

Verify at the official NPI Registry.