NPIMap

Organization Active NPI

Jennie Stuart Medical Center Inc

Doing business as Jennie Stuart Family Health

  • Rural Health Clinic/Center
  • Trenton, KY
National Provider Identifier
1407576580
Registry record updated Nov 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JENNIE STUART MEDICAL CENTER INC
Doing business as
Jennie Stuart Family Health
Practice address
120 N Main St
Trenton, KY 42286-9734
Phone
(270) 466-9300
NPI assigned
Aug 30, 2022
Last updated
Nov 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2025

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

Authorized official

Name
Autumn Bailey
Title
Director of PFS and Managed Care
Phone
(270) 887-0100

Specialties & licenses 1

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

Addresses

Primary practice location

120 N Main St
Trenton, KY 42286-9734

Mailing address

PO Box 2400
Hopkinsville, KY 42241-2400

Other names 1

  • JENNIE STUART FAMILY HEALTH Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040609001506 KY Part B Supplier - Clinic/Group Practice 4183607252 Receives reassigned benefits from 155 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hopkinsville, KY; Trenton, KY; Russellville, KY
O20221230002500 KY Part A Provider - Rural Health Clinic 4183607252 Practice locations: Trenton, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407576580. Details of each certification follow.

Rural health clinic certification: CCN 188556

Legal name
JENNIE STUART MEDICAL CENTER INC
Doing business as
JENNIE STUART FAMILY HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 5, 2022
Last certification
Oct 2, 2017
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Feb 19, 1913 in KY
Enrollment address
120 N Main St
Trenton, KY 42286-9734
Related CCNs
180051

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
18D1015803Jennie Stuart Family Health, Trenton a Department120 North Main St, Trenton, KY 42286Provider-performed microscopyAug 12, 2027

National Provider Directory

National Provider Directory
Tax ID family
Peter R Isele MD17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Beth a McCraw Individual Corporate OfficerChief Nursing Officer Jul 27, 2018
W-2 Managing EmployeeChief Nursing Officer Jul 27, 2018
Elizabeth Shelton Individual Corporate DirectorBoard Member Jan 1, 2021
Eric Lee Individual Contracted Managing EmployeeChief Executive Officer Dec 1, 2007
Corporate OfficerChief Executive Officer Dec 1, 2007
Jared Larry Antczak Individual Corporate DirectorBoard Member Oct 1, 2025
Ovation Health Organization, Brentwood, TN LLC Operational/Managerial Control Dec 5, 2022
Deeann W Sova Individual Corporate DirectorBoard Member Apr 24, 2025
Mark Laramee Individual Contracted Managing EmployeeCfo Jul 1, 2022
Corporate OfficerCfo Jul 1, 2022
Hollis White Individual Corporate DirectorBoard Member Jan 1, 2021
Craig Self Individual Corporate DirectorBoard Member Oct 1, 2025
Leslie H Carroll Individual Corporate DirectorBoard Member Apr 22, 2019
Tarek Toubia Individual Corporate DirectorPresident, Medical Staff Jan 1, 2025
Alissa L Young Individual Corporate DirectorBoard Member Jan 1, 2018
Lynn C Lingafelter Individual Corporate DirectorBoard Member Oct 1, 2025
Tanner Jackson Parrent Individual Corporate DirectorPresident-Elect, Medical Staff Jan 1, 2025
Lydia Francene Gilmer Individual Corporate DirectorBoard Member Oct 1, 2025
Autumn S Bailey Individual W-2 Managing EmployeeDirector of PFS and Managed Care Aug 1, 2017
Phillip Tribble Individual Corporate DirectorBoard Member Nov 1, 2010
Charles Turner Individual Corporate DirectorBoard Member Jan 1, 2018
Deaconess Health Kentucky Inc Organization, Henderson, KY Non-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2025 100%
Marty Bozarth Individual Corporate DirectorBoard Member Jan 1, 2021
Carter Hendricks Individual Corporate DirectorBoard Member Jan 1, 2015

Owners & managing parties with NPI records 4

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

Facilities with the same owner 22

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 22

Change-of-ownership history 1

DateEventCounterparty
Dec 5, 2022 Change of OwnershipThis provider was the buyer Jennie Stuart Medical GroupCCN 188959, KY, NPI 1437602745

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762992000000",
    "number": "1407576580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2400",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422412400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N MAIN ST",
            "city": "TRENTON",
            "state": "KY",
            "postal_code": "422869734",
            "telephone_number": "270-466-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIE STUART MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-30",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "AUTUMN",
        "authorized_official_title_or_position": "DIRECTOR OF PFS AND MANAGED CARE",
        "authorized_official_telephone_number": "270-887-0100"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JENNIE STUART FAMILY HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Trenton, KY

Sources for this page

Verify at the official NPI Registry.