NPIMap

Organization Active NPI

Juniper Health Inc

  • Federally Qualified Health Center (FQHC)
  • Sandy Hook, KY
National Provider Identifier
1669014627
Registry record updated Feb 23, 2021
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
308 N Ky 7
Sandy Hook, KY 41171-9137
Phone
(606) 738-9785
Fax
(859) 317-2148
NPI assigned
Oct 11, 2019
Organization subpart
Yes
Parent organization
JUNIPER HEALTH, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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

Authorized official

Name
Dr. Derrick J Hamilton, DO CEONPI 1376631283
Title
Chief Executive Officer
Phone
(606) 464-0151

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

308 N Ky 7
Sandy Hook, KY 41171-9137

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
31000862MedicaidKY

Other names 1

  • Juniper Health Elliott County 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…
O20200316002271 KY Part A Provider - Federally Qualified Health Center (FQHC) 2961453618 Practice locations: Sandy Hook, KY

Federally qualified health center certification: CCN 181190

Legal name
JUNIPER HEALTH INC
Doing business as
JUNIPER HEALTH ELLIOTT COUNTY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 16, 2020
Last certification
Mar 16, 2020
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 23, 2003 in KY
Enrollment address
308 N Ky 7
Sandy Hook, KY 41171-9137

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

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
18D2175937Juniper Health Elliott County308 N Ky 7, Sandy Hook, KY 41171Certificate of waiverDec 4, 2027

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

  • QPS LLC
    • Community/Retail Pharmacy
    • Sandy Hook, KY
    • NPI 1538901186

    Member Of

    NPD member

Locations

599 Lee Ave
Beattyville, KY 41311
Phone (606) 464-2401

38 J F Green St
Sandy Hook, KY 41171
Phone (606) 738-5545

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 Jul 1, 2021
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 Treasuer Jun 1, 2005
Sharon R Calhoun Individual Corporate DirectorBoard Member 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, 2021

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614038400000",
    "number": "1669014627",
    "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": "308 N KY 7",
            "city": "SANDY HOOK",
            "state": "KY",
            "postal_code": "411719137",
            "telephone_number": "606-738-9785",
            "fax_number": "859-317-2148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUNIPER HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JUNIPER HEALTH, INC",
        "enumeration_date": "2019-10-11",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "606-464-0151",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO  CEO"
    },
    "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 Elliott County",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Juniper Health Elliott County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandy Hook, KY

Sources for this page

Verify at the official NPI Registry.