NPIMap

Organization Active NPI

Fresh Start Health PSC

Doing business as Fresh Start Health Centers Vanceburg

  • Rural Health Clinic/Center
  • Vanceburg, KY
National Provider Identifier
1669252995
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FRESH START HEALTH PSC
Practice address
207 Plummers LN
Vanceburg, KY 41179-7683
Phone
(606) 225-8200
Fax
(888) 606-7354
NPI assigned
Oct 4, 2023
Last updated
Oct 4, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
FRESH START HEALTH PSCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Jerrel H BoyerNPI 1083785075
Title
Ceo
Phone
(773) 296-6666

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
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

207 Plummers LN
Vanceburg, KY 41179-7683

Mailing address

207 Plummers LN
Vanceburg, KY 41179-7683
Phone (606) 225-8200

Other names 1

  • Fresh Start Health Centers Vanceburg Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231027002521 KY Part A Provider - Rural Health Clinic 6204184997 Practice locations: Vanceburg, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669252995. Details of each certification follow.

Rural health clinic certification: CCN B03936

Legal name
FRESH START HEALTH PSC
Doing business as
FRESH START HEALTH CENTERS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 20, 2023
Last certification
Dec 20, 2023
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Feb 15, 2018 in KY
Enrollment address
207 Plummers LN
Vanceburg, KY 41179-7683

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Fresh Start Health PSC3 organizations share this tax ID, including this one
Part of
Fresh Start Health PSC

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Jerrel Boyer Individual 5% Or Greater Direct Ownership InterestPresident Sep 1, 2023 100%
Corporate OfficerPresident Sep 1, 2023 100%
W-2 Managing EmployeePresident Sep 1, 2023 100%
Operational/Managerial ControlPresident Sep 1, 2023 100%
Christopher Tullis Individual Corporate DirectorExecutive Director Sep 1, 2023
Operational/Managerial ControlExecutive Director Sep 1, 2023

Owners & managing parties with NPI records 1

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

  • Jerrel H Boyer, DO
    • Neurological Surgery Physician
    • Chicago, IL
    • NPI 1083785075

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1696377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1669252995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 PLUMMERS LN",
            "city": "VANCEBURG",
            "state": "KY",
            "postal_code": "411797683",
            "telephone_number": "606-225-8200",
            "fax_number": "888-606-7354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 PLUMMERS LN",
            "city": "VANCEBURG",
            "state": "KY",
            "postal_code": "411797683",
            "telephone_number": "606-225-8200",
            "fax_number": "888-606-7354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH START HEALTH PSC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FRESH START HEALTH PSC",
        "enumeration_date": "2023-10-04",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "BOYER",
        "authorized_official_first_name": "JERREL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-296-6666"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fresh Start Health Centers Vanceburg",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fresh Start Health Centers Vanceburg",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Vanceburg, KY

Sources for this page

Verify at the official NPI Registry.