NPIMap

Organization Active NPI

Aaron K. Jonan Memorial Clinic Inc.

Doing business as Aaron Jonan Memorial Clinic

  • Rural Health Clinic/Center
  • Jackson, KY
National Provider Identifier
1477569226
Registry record updated May 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
900029 Issued in KY
Legal business name
AARON K. JONAN MEMORIAL CLINIC INC.
Doing business as
Aaron Jonan Memorial Clinic
Practice address
832 Highway 15 N
Jackson, KY 41339-8284
Phone
(606) 666-5142
Fax
(606) 666-4172
NPI assigned
Aug 1, 2006
Last updated
May 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2023

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

Authorized official

Name
Djien So
Title
Administrator/Access Manager
Phone
(606) 794-5600

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 43629 KY
Rural Health Clinic/Center 261QR1300X 900029 KY Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 3006826 KY

Addresses

Primary practice location

832 Highway 15 N
Jackson, KY 41339-8284

Mailing address

832 Highway 15 N
Jackson, KY 41339-8284
Phone (606) 666-5142

Other names 1

  • Aaron Jonan Memorial Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031218000126 KY Part B Supplier - Clinic/Group Practice 5294632196 Receives reassigned benefits from 14 practitioners
Practice locations: Jackson, KY
O20070125000185 KY Part A Provider - Rural Health Clinic 5294632196 Practice locations: Jackson, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477569226. Details of each certification follow.

Rural health clinic certification: CCN 183821

Legal name
AARON K. JONAN MEMORIAL CLINIC, INC.
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 10, 1994
Last certification
Nov 21, 2019
Ownership / control type
1C
Organization structure
CorporationProprietary
Incorporated
Apr 4, 2000 in KY
Enrollment address
832 Highway 15 N
Jackson, KY 41339-8284

National Provider Directory

National Provider Directory

Locations

832 Highway 15 N
Jackson, KY 41339
Phone (606) 568-9921

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Leonor S Pagtakhan So Individual 5% Or Greater Direct Ownership InterestDirector Jan 1, 2020 50%
W-2 Managing EmployeeAd; Jan 1, 2013 50%
Djien So Individual 5% Or Greater Direct Ownership InterestDirector Apr 4, 2000 50%
Corporate DirectorDirector Apr 4, 2000 50%
W-2 Managing EmployeeAd;MD; Apr 4, 2000 50%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683590400000",
    "number": "1477569226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "832 HIGHWAY 15 N",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413398284",
            "telephone_number": "606-666-5142",
            "fax_number": "606-666-4172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "832 HIGHWAY 15 N",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413398284",
            "telephone_number": "606-666-5142",
            "fax_number": "606-666-4172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AARON K. JONAN MEMORIAL CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A",
        "authorized_official_last_name": "SO",
        "authorized_official_first_name": "DJIEN",
        "authorized_official_title_or_position": "ADMINISTRATOR/ACCESS MANAGER",
        "authorized_official_telephone_number": "606-794-5600"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "43629",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900029",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3006826",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aaron Jonan Memorial Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, KY

Sources for this page

Verify at the official NPI Registry.