NPIMap

Organization Active NPI

Juniper Health Inc

  • Federally Qualified Health Center (FQHC)
  • Hazel Green, KY
National Provider Identifier
1609654276
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JUNIPER HEALTH INC
Practice address
11134 Ky-191
Hazel Green, KY 41332
Phone
(606) 464-0151
NPI assigned
Sep 15, 2023
Organization subpart
Yes
Parent organization
JUNIPER HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Authorized official

Name
Derrick J Hamilton, DONPI 1376631283
Title
Ceo
Phone
(606) 666-9950

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

11134 Ky-191
Hazel Green, KY 41332

Mailing address

PO Box 690
Beattyville, KY 41311-0690
Phone (606) 464-0151

Other identifiers 1

IdentifierTypeStateIssuer
31000862MedicaidKY

Other names 1

  • Juniper Health Red River Elementary School Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050214000128 KY Part B Supplier - Clinic/Group Practice 2961453618 Receives reassigned benefits from 25 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Liberty, KY; Sandy Hook, KY; Rogers, KY; Jackson, KY; Campton, KY; Frenchburg, KY; Hazel Green, KY; Beattyville, KY…
O20231227002161 KY Part A Provider - Federally Qualified Health Center (FQHC) 2961453618 Practice locations: Hazel Green, KY

Federally qualified health center certification: CCN B01114

Legal name
JUNIPER HEALTH INC
Doing business as
JUNIPER HEALTH RED RIVER ELEMENTARY SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 13, 2023
Last certification
Dec 13, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 23, 2004 in KY
Enrollment address
11134 Ky-191
Hazel Green, KY 41332

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Juniper Health Inc15 organizations share this tax ID, including this one
Part of
Juniper Health Inc

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Jamie L Moore Individual Corporate DirectorBoard Member Jul 1, 2021
Lisa Stamper Individual Corporate OfficerBoard Secretary Jan 1, 2011
Burley Hudson Individual Corporate OfficerBoard Chair Jan 1, 2005
Lowell Hamilton Individual Corporate DirectorBoard Member Jul 1, 2021
Cathy Hayes Individual Corporate DirectorBoard Member Jan 1, 2009
Samuel T Faulkner Individual Corporate DirectorBoard Member Apr 1, 2024
Diane Dunahoo Individual Corporate OfficerBoard Treasurer Jun 1, 2005
Sharon R Calhoun Individual Corporate Director Mar 31, 2024
Derrick J Hamilton Individual Corporate OfficerCeo Aug 1, 2019
W-2 Managing EmployeeCeo Aug 1, 2019
Richard Ackley Individual Corporate OfficerCao Aug 1, 2019
W-2 Managing EmployeeCao Aug 1, 2019
Darren Back Individual Corporate DirectorBoard Member Jul 1, 2020

Owners & managing parties with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1694736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721088000000",
    "number": "1609654276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690",
            "city": "BEATTYVILLE",
            "state": "KY",
            "postal_code": "413110690",
            "telephone_number": "606-464-0151",
            "fax_number": "606-464-0152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11134 KY-191",
            "city": "HAZEL GREEN",
            "state": "KY",
            "postal_code": "41332",
            "telephone_number": "606-464-0151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUNIPER HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JUNIPER HEALTH INC",
        "enumeration_date": "2023-09-15",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "606-666-9950",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31000862",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Juniper Health Red River Elementary School",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Juniper Health Red River Elementary School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hazel Green, KY

Sources for this page

Verify at the official NPI Registry.