NPIMap

Organization Active NPI

Priority Primary Care LLC

  • Rural Health Clinic/Center
  • Russellville, KY
National Provider Identifier
1609310358
Registry record updated Mar 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PRIORITY PRIMARY CARE LLC
Practice address
60 Shelton LN
Russellville, KY 42276-7203
Phone
(270) 632-4514
Fax
(270) 632-4518
NPI assigned
Dec 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2018

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

Authorized official

Name
Kumarasooriyar Kumaravelu, MD
Title
Owner
Phone
(270) 632-4514

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Rural Health Clinic/Center 261QR1300X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

60 Shelton LN
Russellville, KY 42276-7203

Mailing address

PO Box 1546
Russellville, KY 42276-3546
Phone (270) 632-4514

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170308000079 KY Part B Supplier - Clinic/Group Practice 8022392216 Receives reassigned benefits from 3 practitioners
Practice locations: Russellville, KY
O20170912002419 KY Part A Provider - Rural Health Clinic 8022392216 Practice locations: Russellville, KY

Rural health clinic certification: CCN 188967

Legal name
PRIORITY PRIMARY CARE LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 9, 2018
Last certification
Jan 9, 2018
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
Nov 3, 2016 in KY
Enrollment address
60 Shelton LN
Russellville, KY 42276-7203

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
18D2126722Priority Primary Care, LLC60 Shelton Lane, Russellville, KY 42276Certificate of waiverMar 2, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Elizabeth Kumaravelu Individual 5% Or Greater Direct Ownership Interest Sep 28, 2021 82%
Corporate DirectorRN Sep 28, 2021
David L McClain Individual 5% Or Greater Direct Ownership Interest Sep 28, 2021 11.5%
W-2 Managing EmployeeNurse Practitioner, Vice Preside Sep 28, 2021
Barbara Purcell Individual 5% Or Greater Direct Ownership Interest Sep 28, 2021 6.5%
W-2 Managing EmployeeAdministrator/Secretary Sep 28, 2021
Carlton a Lee Individual Contracted Managing EmployeeMedical Director May 19, 1985
Corporate DirectorMedical Director Oct 15, 2021

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1481760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519948800000",
    "number": "1609310358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1546",
            "city": "RUSSELLVILLE",
            "state": "KY",
            "postal_code": "422763546",
            "telephone_number": "270-632-4514",
            "fax_number": "270-632-4518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 SHELTON LN",
            "city": "RUSSELLVILLE",
            "state": "KY",
            "postal_code": "422767203",
            "telephone_number": "270-632-4514",
            "fax_number": "270-632-4518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIORITY PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-15",
        "last_updated": "2018-03-02",
        "status": "A",
        "authorized_official_last_name": "KUMARAVELU",
        "authorized_official_first_name": "KUMARASOORIYAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-632-4514",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Russellville, KY

Sources for this page

Verify at the official NPI Registry.