Commonwealth of Kentucky
Organization Active NPI Psychiatric Hospital · Hopkinsville, KY
NPI 1508861683 · NPPES record last updated Aug 7, 2024
Key facts
- NPI
- 1508861683
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric Hospital 283Q00000X
- Legal business name
- COMMONWEALTH OF KENTUCKY
- Practice address
- 2400 Russellville Rd
Hopkinsville, KY 42240-8095 - Phone
- (270) 889-6025
- Fax
- (270) 886-4487
- NPI assigned
- Jun 16, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMONWEALTH OF KENTUCKY
Authorized official
- Name
- Jennifer Moore
- Title
- Assistant Director
- Phone
- (502) 782-6117
Owners & managing parties with NPI records 4
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 2
Practitioners 21
-
Katrena Blackwell, MSN, PMHCNS, ARNP-BC
-
Cameron Allen Brown, D.O.
-
Kimberly Cecil-Riddle, DNP, APRN, FNP-BC
-
Janie Elizabeth Davis, ARNP
-
Mary Linda Dillard, ARNP
-
John Kenneth Guessetto, M.A.
-
Barbara J Newell, MD
-
Irene Y Pasquin, MD
-
Prakash Shah, MD
-
Faisal Siddiqui, MD
-
Carl L Watkins, MD
-
Shahid Ali, MD
-
Uzma S Faheem, M.D
-
William Lee Johnson, M.D.
-
Linda Darlene Naron, APRN
Medicare Care Compare: Hospital
- Listed as
- Western State Hospital
- Type
- Psychiatric
- Ownership
- Government - Local
- Medicare certification status
- Active
- Emergency services
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
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
- Government · Non-profit
- Enrollment address
- 2400 Russellville Rd
Hopkinsville, KY 42240-8095 - Hospital subgroups
- Psychiatric
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Jennifer Moore |
W-2 Managing Employee | May 1, 2015 | |
| Rebecca Frost |
Operational/Managerial Control | Feb 6, 2023 | |
| Katrice D Maddox |
W-2 Managing Employee | Jun 1, 2015 | |
| Dominic English |
Operational/Managerial Control | Feb 6, 2023 | |
| Stephanie Craycraft |
Corporate Director | Sep 1, 2014 | |
| Barbie Johnson |
W-2 Managing Employee |
Jan 3, 2023 | |
| Commonwealth of Kentucky |
Other | Jan 1, 1954 | 100% |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Thomson-Hood Veterans Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 1991 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Commonwealth of Kentucky
- Part of
- West Liberty Elementary
Locations
275 E Main St
#4
Frankfort, KY 40601
2440 Russellville Rd
Hopkinsville, KY 42240
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | |||
| Psychiatric Hospital | 283Q00000X | 100072 | KY | |
| Psychiatric Hospital | 283Q00000X | KY | Yes |
Addresses
Primary practice location
2400 Russellville Rd
Hopkinsville, KY 42240-8095
Mailing address
2440 Russellville Road
Hopkinsville, KY 42240
Phone (270) 889-6025
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65944852 | Medicaid | KY | |
| 02020022 | Medicaid | KY |
Other names
- Western State Hospital
Other providers in Hopkinsville, KY
- Emily Colthart
- Commonwealth Counseling Corp
- Commonwealth Health Corporation, Inc
- Commonwealth of Kentucky
- Commonwealth of Kentucky
- Community Counseling Center LLC
- Comprehensive Care Clinic Ky
- Comprehensive Care Clinic TD PLLC
- Eileen Cook
- Misty G Cook
All providers in Hopkinsville, KY · Psychiatric Hospital in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.