Appalachian Wellness Primary Care LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

APPALACHIAN WELLNESS PRIMARY CARE LLC

Practice address

592 Ky 15 S Ste 1-2
Campton, KY 41301-9552

Phone

(606) 668-9178

Fax

(877) 203-3485

NPI assigned

Apr 15, 2022

Last updated

Aug 10, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Miss Sheri Rose HaasNPI 1518390723

Title

Owner

Phone

(606) 668-9178

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396488656. Details of each certification follow.

• CCN B03919 Rural health clinic · Active · Details

Rural health clinic certification: CCN B03919

Legal name

APPALACHIAN WELLNESS PRIMARY CARE LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Mar 30, 2023

Last certification

Mar 30, 2023

Ownership / control type

1A

Organization structure

OtherProprietary

Incorporated

Mar 16, 2022 in KY

Enrollment address

592 Ky 15 S
Ste 1-2
Campton, KY 41301-9552

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.

Owners & managing parties with NPI records 1

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

• Sheri Lyn Rose Haas, M.A., L.P.P.

  • Clinical Psychologist
  • Campton, KY
  • NPI 1518390723

  5% Or Greater Direct Ownership Interest, Contracted Managing Employee, Corporate Officer, W-2 Managing Employee

  CMS ownership

Practitioners 1

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.

• Sheri Lyn Rose Haas, M.A., L.P.P.

  • Clinical Psychologist
  • Campton, KY
  • NPI 1518390723
  NPD Authorized official

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

{
    "created_epoch": "1649980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1396488656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "592 KY 15 S STE 1-2",
            "city": "CAMPTON",
            "state": "KY",
            "postal_code": "413019552",
            "telephone_number": "606-668-9178",
            "fax_number": "877-203-3485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "592 KY 15 S STE 1-2",
            "city": "CAMPTON",
            "state": "KY",
            "postal_code": "413019552",
            "telephone_number": "606-668-9178",
            "fax_number": "877-203-3485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APPALACHIAN WELLNESS PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-15",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A",
        "authorized_official_last_name": "ROSE HAAS",
        "authorized_official_first_name": "SHERI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-668-9178",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "officeally",
            "affiliation": "N",
            "address_1": "592 Ky 15 S Ste 1-2",
            "city": "Campton",
            "state": "KY",
            "country_code": "US",
            "postal_code": "413019552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristian Renee Allen, PMHNP-BC
• Allergy Asthma and Immunology
• Ambulatory Care Services PLLC (Saint Luke's Family and Mult I Specialty Clinic)
• Tammy Renee Angel
• Appalachian Wellness Laboratory Services
• Appalachian Wellness, L.L.C.
• Adrian Clint Banks, D.O.
• Alissa Leigh Bell, APRN
• Sandra Kaye Benham, APRN
• Carla Bowling, LPCC

• Rural Health Clinic/Center in Campton, KY
• Providers in Campton, KY by specialty
• Rural Health Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.