NPIMap

Casey County Hospital District

Organization Active NPI Rural Health Clinic/Center · Liberty, KY

NPI 1679720114 · NPPES record last updated Aug 23, 2023

Key facts

NPI
1679720114
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
CASEY COUNTY HOSPITAL DISTRICT
Practice address
199 Adams St
Liberty, KY 42539-3064
Phone
(606) 787-5044
Fax
(606) 787-0251
NPI assigned
Aug 27, 2008
Organization subpart
Yes
Parent organization (as reported)
CASEY COUNTY HOSPITAL DISTRICT

Authorized official

Name
Mr. Rex A. Tungate, CEO
Title
Administrator
Phone
(606) 787-6275

Owners & managing parties with NPI records 3

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

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 2

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

Other NPIs with the same Medicare PAC ID 3

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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 28

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

View all 28

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D1090495Casey County Family Practice
199 Adams St, Liberty, KY 42539		Certificate of waiverOct 12, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in KY

Rural health clinic certification: CCN 183466

Legal name
CASEY COUNTY HOSPITAL DISTRICT
Doing business as
CASEY COUNTY FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 13, 2009
Last certification
May 6, 2014
Ownership / control type
2B
Organization structure
Other · Non-profit
Enrollment address
199 Adams St
Liberty, KY 42539-3064
Related CCNs
181309

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Casey County Hospital District
Organization · Liberty, KY 		5% Or Greater Direct Ownership Interest Jan 29, 2009 100%
Rex Tungate
Individual 		Corporate Officer
Ceo		 Nov 17, 2007
W-2 Managing Employee Nov 16, 2016
Tungate Healthcare Enterprises Inc
Organization · Campbellsville, KY
Management services company 		Operational/Managerial Control Nov 17, 2007
Karen Atwood
Individual 		Corporate Officer
Secretary/Treasurer		 May 10, 2011
Ronald Wright
Individual 		Corporate Officer Feb 1, 2018
Robert T Rousey
Individual 		Corporate Director
Trustee		 Oct 13, 2015
Dan Johnson
Individual 		Corporate Officer Nov 1, 2019

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Casey County Hospital District
Liberty, KY · CCN 181309		 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2007
Casey County Hospital Swing Bed Unit
Liberty, KY · CCN 18Z309		 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2007
Casey County Primary Care
Liberty, KY · CCN 183428		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2007

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031110000044 KY Part B Supplier - Clinic/Group Practice 0749193423 Receives reassigned benefits from 29 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Liberty, KY
O20090403000214 KY Part a Provider - Rural Health Clinic 0749193423 Practice locations: Liberty, KY

National Provider Directory

Part of
Casey County Hospital District

Locations

112 Liberty Sq
Liberty, KY 42539
Phone (606) 787-5044

199 Adams St
Liberty, KY 42539
Phone (606) 787-5044

195 N Wallace Wilkinson Blvd
Ste A
Liberty, KY 42539
Phone (606) 787-2790

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

199 Adams St
Liberty, KY 42539-3064

Mailing address

199 Adams St
Liberty, KY 42539-3064
Phone (606) 787-5044

Other identifiers

IdentifierTypeStateIssuer
7100070150MedicaidKY

Other names

  • Casey County Family Practice Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 23, 2023.

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1679720114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 ADAMS ST",
            "city": "LIBERTY",
            "state": "KY",
            "postal_code": "425393064",
            "telephone_number": "606-787-5044",
            "fax_number": "606-787-0251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 ADAMS ST",
            "city": "LIBERTY",
            "state": "KY",
            "postal_code": "425393064",
            "telephone_number": "606-787-5044",
            "fax_number": "606-787-0251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASEY COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CASEY COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2008-08-27",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A",
        "authorized_official_last_name": "TUNGATE",
        "authorized_official_first_name": "REX",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "606-787-6275",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100070150",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Casey County Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Casey County Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Liberty, KY

All providers in Liberty, KY · Rural Health Clinic/Center in Kentucky

Sources for this page

Verify at the official NPI Registry.