NPIMap

Organization Active NPI

Juniper Health Inc

Doing business as Lee County Family Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Beattyville, KY
National Provider Identifier
1669588505
Registry record updated Mar 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
700132 Issued in KY
Legal business name
JUNIPER HEALTH INC
Doing business as
Lee County Family Medical Clinic
Practice address
141 Main Street
Beattyville, KY 41311
Phone
(606) 464-0151
Fax
(606) 464-0152
NPI assigned
Aug 22, 2006
Last updated
Mar 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2020

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

Authorized official

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

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 700132 KY Primary

Addresses

Primary practice location

141 Main Street
Beattyville, KY 41311

Mailing address

141 Main Street
P.O. Box 690
Beattyville, KY 41311
Phone (606) 464-0151

Other identifiers 2

IdentifierTypeStateIssuer
31000862MedicaidKY
31000854MedicaidKY

Other names 1

  • Lee County Family Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050527000543 KY Part A Provider - Federally Qualified Health Center (FQHC) 2961453618 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beattyville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669588505. Details of each certification follow.

Federally qualified health center certification: CCN 181848

Legal name
JUNIPER HEALTH INC
Doing business as
LEE COUNTY FAMILY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 25, 2005
Last certification
Jul 25, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 24, 2003 in KY
Enrollment address
1025 Grand Avenue
Beattyville, KY 41311-7484

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

141 Main St
Old Landing, KY 41311

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 Aug 1, 2021
Lisa Stamper Individual Corporate OfficerBoard Secretary Aug 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 Treasurer 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 Aug 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.

Subparts reporting this organization as parent 17

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

View all 17

Practitioners & affiliated clinicians

Practitioners 10

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": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585267200000",
    "number": "1669588505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 MAIN STREET",
            "address_2": "P.O. BOX 690",
            "city": "BEATTYVILLE",
            "state": "KY",
            "postal_code": "41311",
            "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": "141 MAIN STREET",
            "city": "BEATTYVILLE",
            "state": "KY",
            "postal_code": "41311",
            "telephone_number": "606-464-0151",
            "fax_number": "606-464-0152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUNIPER HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2020-03-27",
        "certification_date": "2020-03-27",
        "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, CEO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "KY",
            "license": "700132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31000862",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31000854",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lee County Family Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beattyville, KY

Sources for this page

Verify at the official NPI Registry.