Fresh Start Health PSC
Organization Active NPI Rural Health Clinic/Center · Vanceburg, KY
NPI 1669252995 · NPPES record last updated Oct 4, 2023
Key facts
- NPI
- 1669252995
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 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
- Organization subpart
- Yes
- Parent organization (as reported)
- FRESH START HEALTH PSC
Authorized official
- Name
- Jerrel H Boyer
- Title
- Ceo
- Phone
- (773) 296-6666
Owners & managing parties with NPI records 1
-
Jerrel H Boyer, DO
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 2
Practitioners 10
-
Jackilyn Byrd, APRN
-
Candy A Colyer, LCSW-S
-
Freda Elaine Fields, APRN FNP-C
-
Bethel Anna Hall, APRN
-
Jennifer Mary Rice, APRN
-
Maryellen Tussey, NP
-
Flash Phipps, LPCC
-
Jerrel H Boyer, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
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
- Corporation · Proprietary
- Incorporated
- Feb 15, 2018 in KY
- Enrollment address
- 207 Plummers LN
Vanceburg, KY 41179-7683
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Jerrel Boyer |
5% Or Greater Direct Ownership Interest |
Sep 1, 2023 | 100% |
| Corporate Officer |
Sep 1, 2023 | 100% | |
| W-2 Managing Employee |
Sep 1, 2023 | 100% | |
| Operational/Managerial Control |
Sep 1, 2023 | 100% | |
| Christopher Tullis |
Corporate Director |
Sep 1, 2023 | |
| Operational/Managerial Control |
Sep 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231027002521 | KY | Part a Provider - Rural Health Clinic | 6204184997 | Practice locations: Vanceburg, KY |
National Provider Directory
- Tax ID family
- Fresh Start Health PSC
- Part of
- Fresh Start Health PSC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
- Fresh Start Health Centers Vanceburg
Other providers in Vanceburg, KY
- Mark Fairchild
- Family Medical Center
- First Choice Services, LLC
- William Chalmer Frazier
- Whitney Freno
- Glenda J Gayheart
- Genesis Respiratory Services Inc
- Amanda Nicole Ginn
- John R Grabill
- Grabills Body Shop, LLC
All providers in Vanceburg, 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 Oct 4, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.