NPIMap

Organization Active NPI

Casey County Hospital District

Doing business as Casey County Family Practice

  • Rural Health Clinic/Center
  • Liberty, KY
National Provider Identifier
1679720114
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CASEY COUNTY HOSPITAL DISTRICT
Doing business as
Casey County Family Practice
Practice address
199 Adams St
Liberty, KY 42539-3064
Phone
(606) 787-5044
Fax
(606) 787-0251
NPI assigned
Aug 27, 2008
Last updated
Aug 23, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CASEY COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Authorized official

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

Specialties & licenses 1

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

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 names 1

  • Casey County Family Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679720114. Details of each certification follow.

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
OtherNon-profit
Enrollment address
199 Adams St
Liberty, KY 42539-3064
Related CCNs
181309

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

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
18D1090495Casey County Family Practice199 Adams St, Liberty, KY 42539Certificate of waiverOct 12, 2026

National Provider Directory

National Provider Directory
Part of
Casey County Primary Care Nursing Group

Locations

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

Ownership & related parties

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 OfficerCeo 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 OfficerSecretary/Treasurer May 10, 2011
Ronald Wright Individual Corporate Officer Feb 1, 2018
Robert T Rousey Individual Corporate DirectorTrustee Oct 13, 2015
Dan Johnson Individual Corporate Officer Nov 1, 2019

Owners & managing parties with NPI records 3

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

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 DistrictLiberty, KY, CCN 181309 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2007
Casey County Hospital Swing Bed UnitLiberty, KY, CCN 18Z309 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2007
Casey County Primary CareLiberty, KY, CCN 183428 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2007

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 27

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.

View all 27

NPI Registry JSON

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

{
    "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": [],
    "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

Sources for this page

Verify at the official NPI Registry.