T J Samson Community Hospital
Organization Active NPI Rural Health Clinic/Center · Cave City, KY
NPI 1629429360 · NPPES record last updated Mar 30, 2023
Key facts
- NPI
- 1629429360
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- T J SAMSON COMMUNITY HOSPITAL
- Practice address
- 440 E Happy Valley St
Cave City, KY 42127-8844 - Phone
- (270) 773-2111
- Fax
- (270) 773-2117
- NPI assigned
- Jun 23, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- T J REGIONAL HEALTH INC
Authorized official
- Name
- Neil Thornbury
- Title
- Ceo
- Phone
- (270) 651-4159
Owners & managing parties with NPI records 3
-
Amy N Cassady, DMD
-
Kylend Kiser, M.D.
Other NPIs with the same Medicare PAC ID 7
Related certifications (CCN) 2
Facilities with the same owner 12
Practitioners 240
-
Christie Ann Boone, PAC
-
William J Bradshaw, PA-C
-
Eric L Fisher, M.D.
-
Nancy Jo Houchens, APRN
-
Amelia R Kiser, MD
-
Bethany Alexandra Pare, PA-C
-
Zakare Salifu, DO
-
Alexis N Sherfey, APRN
-
William C Thornbury Jr., M.D.
-
Micah Jade Tracy, APRN
-
Paula N West, APRN
-
Tracy L. Taylor, APRN
-
Tiffany R Frye, APRN
-
Kylend Kiser, M.D.
-
Haley C Mallory, APRN
-
April Martin, LCSW
-
Traci D Anderson, APRN
-
Florin D Andreca, M.D.
-
Todd A. Bader, M.D.
-
Nellie S Bell, CNM, NP
-
Kimberly A Bowman, APRN
-
Kevin J Buntin, CRNA
-
Megan L Buntin, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2115275 | T J Health Cave City Clinic | Certificate of waiver | Sep 3, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Rural health clinic certification: CCN 183493
- Legal name
- T J SAMSON COMMUNITY HOSPITAL
- Doing business as
- T J HEALTH CAVE CITY
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 2, 2016
- Last certification
- Nov 2, 2016
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 6, 1978 in KY
- Enrollment address
- 440 E Happy Valley St
Cave City, KY 42127-8844 - Related CCNs
- 180017
All disclosed owners & managing parties 22
| Name | Role | Since | Share |
|---|---|---|---|
| Thomas Rich Alexander |
Corporate Director |
Aug 1, 2016 | |
| Ladonna G Rogers |
Corporate Officer |
Jan 1, 2021 | |
| Stacey Biggs |
Corporate Officer |
Jan 1, 2021 | |
| Neil C Thornbury |
Corporate Officer |
Jan 1, 2021 | |
| W-2 Managing Employee |
Jan 1, 2021 | ||
| Jodie Holgate |
Corporate Officer |
Jan 1, 2021 | |
| Bo Matthews |
Corporate Director |
Jan 1, 2021 | |
| TJ Regional Health Inc |
Operational/Managerial Control | Aug 1, 2016 | |
| Ervin Sorrell |
Corporate Director |
Jan 1, 2021 | |
| Michael S Young |
Corporate Director |
Aug 1, 2016 | |
| Brent Billingsley |
Corporate Director |
Jan 1, 2020 | |
| Brandon Dickey |
Corporate Officer |
Jan 1, 2021 | |
| James Lee |
Corporate Officer |
Jan 1, 2021 | |
| Mei Deng |
Corporate Officer |
Jan 1, 2021 | |
| Christy Biggerstaff |
W-2 Managing Employee |
Jan 1, 2021 | |
| Cornelius Faulkner |
Corporate Director |
May 1, 2022 | |
| Amy N Norris-Cassady |
Corporate Director |
May 1, 2022 | |
| Michael Andrew Saridakis |
Corporate Director |
Jan 1, 2022 | |
| Daniel Foutch |
Corporate Director |
Aug 1, 2016 | |
| Jennifer Cerwinske |
Corporate Officer |
Jan 1, 2021 | |
| Joseph Botts |
Corporate Director |
Aug 1, 2016 | |
| Henry Royse |
Corporate Director |
Aug 1, 2016 | |
| Kylend Hollie Kiser |
Corporate Director |
Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160912001182 | KY | Part a Provider - Rural Health Clinic | 0648182600 | Practice locations: Cave City, KY |
| O20161005001505 | KY | Part B Supplier - Clinic/Group Practice | 0648182600 |
Receives reassigned benefits from 17 practitioners Practice locations: Glasgow, KY; Cave City, KY |
National Provider Directory
Locations
440 E Happy Valley St
Cave City, KY 42127
Phone (270) 773-2111
1337 N Race St
#C
Glasgow, KY 42141
Phone (270) 629-3376
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
440 E Happy Valley St
Cave City, KY 42127-8844
Mailing address
PO Box 645996
Cincinnati, OH 45264-5996
Phone (270) 651-4444
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100466600 | Medicaid | KY |
Other names
- T J Health Cave City
Other providers in Cave City, KY
- Michaela Stephens
- Christopher Dale Steward
- April Lee Stone
- Jeni Strednak
- Beth Gail Sturgeon
- Paula N West
- Roger Todd Williams
All providers in Cave City, 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 Mar 30, 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.