NPIMap

Organization Active NPI

Frontier Medical Associates of Prestonsburg Inc

  • Rural Health Clinic/Center
  • Prestonsburg, KY
National Provider Identifier
1447840798
Registry record updated Jan 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FRONTIER MEDICAL ASSOCIATES OF PRESTONSBURG INC
Practice address
400 University Dr Ste 211a
Prestonsburg, KY 41653-1080
Phone
(606) 886-6622
Fax
(606) 886-1173
NPI assigned
Jan 21, 2021
Last updated
Jan 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2022

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

Authorized official

Name
Dr. Antoin Hana, M.D.NPI 1669483830
Title
Owner
Phone
(606) 471-2434

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Rural Health Clinic/Center 261QR1300X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

400 University Dr Ste 211a
Prestonsburg, KY 41653-1080

Mailing address

PO Box 697
Prestonsburg, KY 41653-0697
Phone (606) 886-6622

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210408001619 KY Part B Supplier - Clinic/Group Practice 8123436219 Receives reassigned benefits from 34 practitioners
Practice locations: Prestonsburg, KY
O20210611001311 KY Part A Provider - Rural Health Clinic 8123436219 Practice locations: Prestonsburg, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447840798. Details of each certification follow.

Rural health clinic certification: CCN B03847

Legal name
FRONTIER MEDICAL ASSOCIATES OF PRESTONSBURG INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 21, 2021
Last certification
Oct 24, 2024
Ownership / control type
1A
Organization structure
CorporationProprietary
Incorporated
Jan 20, 2021 in KY
Enrollment address
400 University Dr
Ste 211a
Prestonsburg, KY 41653-1080

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
18D2210599Frontier Medical Associates of Prestonsburg, Inc400 University Drive Stes 211a, 102B and 101, Prestonsburg, KY 41653RegistrationMay 17, 2028

National Provider Directory

National Provider Directory

Locations

400 University Dr
Ste 211A
Prestonsburg, KY 41653
Phone (606) 886-6622

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
Antoin Hana Individual 5% Or Greater Direct Ownership InterestMD Jan 20, 2021 100%
Corporate OfficerCeo Jan 20, 2021 100%
Corporate DirectorMedical Director Jan 20, 2021 100%
W-2 Managing EmployeeMD Jan 20, 2021 100%

Owners & managing parties with NPI records 1

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

  • Antoin Hana, M.D.
    • Pediatrics Physician
    • Prestonsburg, KY
    • NPI 1669483830

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

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641513600000",
    "number": "1447840798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 697",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416530697",
            "telephone_number": "606-886-6622",
            "fax_number": "606-886-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 UNIVERSITY DR STE 211A",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416531080",
            "telephone_number": "606-886-6622",
            "fax_number": "606-886-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRONTIER MEDICAL ASSOCIATES OF PRESTONSBURG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-21",
        "last_updated": "2022-01-07",
        "certification_date": "2022-01-07",
        "status": "A",
        "authorized_official_last_name": "HANA",
        "authorized_official_first_name": "ANTOIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-471-2434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prestonsburg, KY

Sources for this page

Verify at the official NPI Registry.