NPIMap

Organization Active NPI

Juniper Health Inc

Doing business as Breathitt County Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Jackson, KY
National Provider Identifier
1467417691
Registry record updated May 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
700140 Issued in KY
Legal business name
JUNIPER HEALTH INC
Doing business as
Breathitt County Family Health Center
Practice address
1484 Lakeside Drive
Jackson, KY 41339-7370
Phone
(606) 666-9950
Fax
(606) 666-9136
NPI assigned
Apr 19, 2006
Last updated
May 12, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
JUNIPER HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2025

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

Authorized official

Name
Derrick J Hamilton, DONPI 1376631283
Title
Ceo
Phone
(606) 666-9950

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU
Federally Qualified Health Center (FQHC) 261QF0400X 700140 KY Primary

Addresses

Primary practice location

1484 Lakeside Drive
Jackson, KY 41339-7370

Mailing address

PO Box 690
Beattyville, KY 41311-0690
Phone (606) 464-0151

Other identifiers 3

IdentifierTypeStateIssuer
31000862MedicaidKY
181853OtherKYMEDICARE FQHC PTAN
9521OtherKYMEDICARE PART B

Other names 1

  • Breathitt County Family Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050214000128 KY Part B Supplier - Clinic/Group Practice 2961453618 Receives reassigned benefits from 25 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Liberty, KY; Sandy Hook, KY; Rogers, KY; Jackson, KY; Campton, KY; Frenchburg, KY; Hazel Green, KY; Beattyville, KY…
O20060131000899 KY Part A Provider - Federally Qualified Health Center (FQHC) 2961453618 Practice locations: Jackson, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467417691. Details of each certification follow.

Federally qualified health center certification: CCN 181853

Legal name
JUNIPER HEALTH INC
Doing business as
JHI BREATHITT COUNTY FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 15, 2006
Last certification
Feb 15, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 3, 2003 in KY
Enrollment address
1484 Lakeside Dr
Jackson, KY 41339-6555

Other NPIs with the same Medicare PAC ID 16

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

  • Juniper Health Inc

    dba Juniper Health Rogers Elementary School

    • Federally Qualified Health Center (FQHC)
    • Rogers, KY
    • NPI 1114705944

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Breathitt Elementary

    • Federally Qualified Health Center (FQHC)
    • Jackson, KY
    • NPI 1124807177

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Breathitt High School

    • Federally Qualified Health Center (FQHC)
    • Jackson, KY
    • NPI 1164201117

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Lee County Family Medical Clinic

    • Federally Qualified Health Center (FQHC)
    • Beattyville, KY
    • NPI 1407818628

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Menifee County

    • Federally Qualified Health Center (FQHC)
    • Frenchburg, KY
    • NPI 1447037122

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Morgan County

    • Federally Qualified Health Center (FQHC)
    • West Liberty, KY
    • NPI 1447791512

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Sebastian Elementary School

    • Federally Qualified Health Center (FQHC)
    • Jackson, KY
    • NPI 1528847670

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Red River Elementary School

    • Federally Qualified Health Center (FQHC)
    • Hazel Green, KY
    • NPI 1609654276

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Wolfe County Middle School

    • Federally Qualified Health Center (FQHC)
    • Campton, KY
    • NPI 1619755287

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Elliott County

    • Federally Qualified Health Center (FQHC)
    • Sandy Hook, KY
    • NPI 1669014627

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Lee County Middle High School

    • Federally Qualified Health Center (FQHC)
    • Beattyville, KY
    • NPI 1679354898

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Highland-Turner Elementary

    • Federally Qualified Health Center (FQHC)
    • Booneville, KY
    • NPI 1750160123

    2961453618

    Same PAC ID
View all 16

Other NPIs on the same Medicare enrollment 16

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

View all 16

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
18D0975290Juniper Health Inc Dba Jhi Breathitt County Family1484 Lakeside Drive, Jackson, KY 41339Certificate of waiverFeb 21, 2028

National Provider Directory

National Provider Directory
Part of
Juniper Health Inc

Locations

265 Highway 15 S
Ste 3
Jackson, KY 41339

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Jamie L Moore Individual Corporate DirectorBoard Member Jun 1, 2022
Lisa Stamper Individual Corporate OfficerBoard Secretary Jun 23, 2023
Burley Hudson Individual Corporate OfficerBoard Chair Jan 1, 2005
Lowell Hamilton Individual Corporate DirectorBoard Member May 1, 2023
Cathy Hayes Individual Corporate DirectorBoard Member Jan 1, 2009
Samuel T Faulkner Individual Corporate DirectorBoard Member Apr 1, 2024
Diane Dunahoo Individual Corporate OfficerBoard Treasurer Jun 1, 2005
Sharon R Calhoun Individual Corporate DirectorBoard Member Mar 31, 2024
Derrick J Hamilton Individual Corporate OfficerCeo Aug 1, 2019
W-2 Managing EmployeeCeo Mar 1, 2007
Richard Ackley Individual Corporate OfficerCao Aug 1, 2019
W-2 Managing EmployeeCao Aug 1, 2019
Darren Back Individual Corporate DirectorBoard Member Jun 23, 2023

Owners & managing parties with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747008000000",
    "number": "1467417691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690",
            "city": "BEATTYVILLE",
            "state": "KY",
            "postal_code": "413110690",
            "telephone_number": "606-464-0151",
            "fax_number": "606-464-0152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1484 LAKESIDE DRIVE",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413397370",
            "telephone_number": "606-666-9950",
            "fax_number": "606-666-9136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUNIPER HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JUNIPER HEALTH INC",
        "enumeration_date": "2006-04-19",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "606-666-9950",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "KY",
            "license": "700140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31000862",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE FQHC PTAN",
            "identifier": "181853",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "9521",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Breathitt County Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Breathitt County Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, KY

Sources for this page

Verify at the official NPI Registry.