NPIMap

Organization Active NPI

Commonwealth of Kentucky

Doing business as Western State Hospital

  • Psychiatric Hospital
  • Hopkinsville, KY
National Provider Identifier
1508861683
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
COMMONWEALTH OF KENTUCKY
Doing business as
Western State Hospital
Practice address
2400 Russellville Rd
Hopkinsville, KY 42240-8095
Phone
(270) 889-6025
Fax
(270) 886-4487
NPI assigned
Jun 16, 2005
Last updated
Aug 7, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMONWEALTH OF KENTUCKYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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

Authorized official

Name
Jennifer Moore
Title
Assistant Director
Phone
(502) 782-6117

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X
Psychiatric Hospital 283Q00000X 100072 KY
Psychiatric Hospital 283Q00000X KY Primary

Addresses

Primary practice location

2400 Russellville Rd
Hopkinsville, KY 42240-8095

Mailing address

2440 Russellville Road
Hopkinsville, KY 42240
Phone (270) 889-6025

Other names 1

  • Western State Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040816000397 KY Part B Supplier - Clinic/Group Practice 9436122710 Receives reassigned benefits from 69 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Louisville, KY; Somerset, KY; Lexington, KY; Hopkinsville, KY
O20110103000177 KY Part A Provider - Hospital 1456255942 Practice locations: Hopkinsville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508861683. Details of each certification follow.

Hospital certification: CCN 184002

Legal name
COMMONWEALTH OF KENTUCKY
Doing business as
WESTERN STATE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 1, 1966
Last certification
Jun 25, 2008
Beds
495 (222 certified)
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Enrollment address
2400 Russellville Rd
Hopkinsville, KY 42240-8095
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Western State HospitalCCN 184002 · All quality measures
Type
Psychiatric
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Commonwealth of Kentucky3 organizations share this tax ID, including this one
Part of
Anderson County Health Dept

Other organizations with this tax ID 2

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

Member of 1

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

  • Commonwealth of Kentucky

    dba Joseph Eddie Ballard Western Kentucky Veterans Center

    • Nursing Facility/Intermediate Care Facility
    • Hanson, KY
    • NPI 1063784197

    Member Of

    NPD member

Locations

275 E Main St
#4
Frankfort, KY 40601

2400 Russellville Rd
Hopkinsville, KY 42240
Phone (270) 886-4431

2440 Russellville Rd
Hopkinsville, KY 42240

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Jennifer Moore Individual W-2 Managing Employee May 1, 2015
Rebecca Frost Individual Operational/Managerial Control Feb 6, 2023
Katrice D Maddox Individual W-2 Managing Employee Jun 1, 2015
Dominic English Individual Operational/Managerial Control Feb 6, 2023
Stephanie Craycraft Individual Corporate Director Sep 1, 2014
Barbie Johnson Individual W-2 Managing EmployeeCfo Jan 3, 2023
Commonwealth of Kentucky Organization, Frankfort, KY Other Jan 1, 1954 100%

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Thomson-Hood Veterans CenterWilmore, KY, CCN 185473 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1991

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1508861683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2440 RUSSELLVILLE ROAD",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "42240",
            "telephone_number": "270-889-6025",
            "fax_number": "270-886-4487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 RUSSELLVILLE RD",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422408095",
            "telephone_number": "270-889-6025",
            "fax_number": "270-886-4487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH OF KENTUCKY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMONWEALTH OF KENTUCKY",
        "enumeration_date": "2005-06-16",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ASSISTANT DIRECTOR",
        "authorized_official_telephone_number": "502-782-6117"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "KY",
            "license": "100072",
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western State Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Western State Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hopkinsville, KY

Sources for this page

Verify at the official NPI Registry.