Saint Joseph Health System, Inc.
Organization Active NPI Rural Health Clinic/Center · London, KY
NPI 1508918533 · NPPES record last updated Jan 25, 2023
Key facts
- NPI
- 1508918533
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 900090 (KY)
- Legal business name
- SAINT JOSEPH HEALTH SYSTEM, INC.
- Practice address
- 378 Thompson Poynter Rd
London, KY 40741-7238 - Phone
- (606) 877-3990
- Fax
- (606) 877-3993
- NPI assigned
- Jan 18, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- SAINT JOSEPH HEALTH SYSTEM, INC.
Authorized official
- Name
- Christy Spitser
- Title
- VP of Finance
- Phone
- (859) 313-1694
Owners & managing parties with NPI records 2
-
Emmanuel C. Yumang, M.D.
Owned or controlled facilities with NPI records 5
Other NPIs with the same Medicare PAC ID 14
Corporate family (same tax ID) 20
Related certifications (CCN) 1
Facilities with the same owner 12
Practitioners 37
-
Diana Mae Bratcher, APRN
-
James Michael Brown, D.O.
-
Donnie W Bunch, D.O.
-
Nicolas P. Burnett, M.D.
-
Erin Kennedy Butler, PA-C
-
Ashley Danielle Callebs, APRN
-
Pamela A Combs, MD
-
Donna Crockett, APRN
-
Malia Beth Dimeling, APRN
-
Candice J Fox, APRN
-
Bill Junior Hacker, M.D.
-
Donny Hardy, MD
-
Nicola Jabbour, M.D
-
Risham Javaid, MD
-
Regina Kaur, MD
-
Jacqueline R Matar, M.D.
-
Trina R. Mattingly, APRN
-
Denise Maynes, APRN
-
Alexis Paige McWhorter, APRN
-
Heather Marie Mills, APRN, FNP-C
-
Kelly Jo Napier, APRN
-
Muhammad A Niazi, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D0893094 | London Pediatric & Adolescent Medicine | Provider-performed microscopy | Apr 23, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Rural health clinic certification: CCN 183435
- Legal name
- SAINT JOSEPH HEALTH SYSTEM INC
- Doing business as
- LONDON PEDIATRIC AND ADOLESCENT MEDICINE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 30, 1997
- Last certification
- Oct 2, 2017
- Ownership / control type
- 2B
- Most recent change of ownership
- Jul 1, 2008 (1 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 30, 1998 in KY
- Enrollment address
- 378 Thompson Poynter Rd
London, KY 40741-7238 - Related CCNs
- 180011
All disclosed owners & managing parties 21
| Name | Role | Since | Share |
|---|---|---|---|
| Tracey Gilbert |
W-2 Managing Employee |
Dec 1, 2022 | |
| Commonspirit Health |
5% Or Greater Indirect Ownership Interest | Jan 1, 2012 | 100% |
| Adeline Fehribach |
Corporate Officer | Jul 1, 2021 | |
| Matthew Brown |
Corporate Officer |
Jul 1, 2025 | |
| Corporate Director |
Jul 1, 2025 | ||
| Jane J Chiles |
Corporate Director |
Sep 1, 2013 | |
| Matthew L Grimshaw |
Corporate Director |
Jul 1, 2025 | |
| Kentuckyone Health Inc |
5% Or Greater Direct Ownership Interest | Sep 1, 2013 | 100% |
| Terika Richardson Mbanu |
Corporate Director |
Jul 1, 2025 | |
| Donald D Hearne |
Corporate Officer |
Jul 1, 2025 | |
| Mary-Alicha Weldon |
Corporate Director | Jul 1, 2020 | |
| Thomas Kopfensteiner |
Corporate Director |
Jul 1, 2025 | |
| Christy L Spitser |
W-2 Managing Employee |
Mar 1, 2014 | |
| Daniel C Rodrigue |
Corporate Director | Jul 1, 2021 | |
| Emmanuel C Yumang |
Corporate Officer | Jul 1, 2024 | |
| Martha Jones |
Corporate Director |
Jul 1, 2025 | |
| Monica Kennison |
Corporate Officer | Jul 1, 2024 | |
| Granetta Blevins |
Corporate Officer | Jul 1, 2022 | |
| Winston Griffin |
Corporate Officer | Jul 1, 2021 | |
| Melissa Moore Murphy |
Corporate Officer | Jul 1, 2021 | |
| Daryl Love |
Corporate Officer | Jul 1, 2024 | |
| Kim Potter-Blair |
Corporate Officer | Jul 1, 2021 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Continuing Care Hospital Inc |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Sep 30, 1998 |
| CHI Saint Joseph Berea |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2012 |
| CHI Saint Joseph London |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2008 |
| CHI Saint Joseph Berea NF |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100429000282 | KY | Part a Provider - Rural Health Clinic | 4183641400 | Practice locations: London, KY |
National Provider Directory
- Tax ID family
- Saint Joseph Hospital Pharmacy
- Part of
- Saint Joseph Hospital Pharmacy
Locations
14659 N US Highway 25 E
Ste 16
Corbin, KY 40701
Phone (606) 280-7070
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 900090 | KY | Yes |
Addresses
Primary practice location
378 Thompson Poynter Rd
London, KY 40741-7238
Mailing address
PO Box 936
London, KY 40743-0936
Phone (606) 330-7835
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100330000 | Medicaid | KY |
Other names
- London Pediatric & Adolescent Medicine
Other providers in London, KY
- Saint Joseph Health System Inc.
- Saint Joseph Health System, Inc
- Saint Joseph Health System, Inc
- Saint Joseph Health System, Inc
- Saint Joseph Health System, Inc.
- Saint Joseph Health System, Inc.
- Saint Joseph Medical Foundation, Inc
- Saint Joseph Medical Foundation, Inc
- Saint Joseph Medical Foundation, Inc
- Saint Joseph Medical Foundation, Inc
All providers in London, KY · Rural Health Clinic/Center in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2023. 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.