Clover Fork Outpatient Medical Project Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

CLOVER FORK OUTPATIENT MEDICAL PROJECT INC

Practice address

101 Chad St
Clover Fork Clinic
Evarts, KY 40828-8200

Phone

(606) 837-2108

Fax

(606) 837-9389

NPI assigned

Jun 11, 2006

Last updated

Nov 19, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Britt Lewis Jr.

Title

Administrator

Phone

(606) 837-2108

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811939366. Details of each certification follow.

• CCN 181078 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 181078

Legal name

CLOVER FORK OUTPATIENT MEDICAL PROJECT INC

Doing business as

CLOVER FORK CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jan 22, 2018

Last certification

Jan 22, 2018

Ownership / control type

For profit – partnership

Organization structure

CorporationNon-profit

Incorporated

Jan 12, 1970 in KY

Enrollment address

101 Chad St
Evarts, KY 40828-8200

Other NPIs with the same Medicare PAC ID 1

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

• Clover Fork Outpatient Medical Project Inc

  • Federally Qualified Health Center (FQHC)
  • Harlan, KY
  • NPI 1497195036

  2062317027

  Same PAC ID

Locations

All disclosed owners & managing parties 10

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

Practitioners 6

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.

• Michael W Napier, PAC

  • Physician Assistant
  • Evarts, KY
  • NPI 1164466066
  Medicare reassignment Care Compare group
• Eric N Roberts, PAC

  • Physician Assistant
  • Evarts, KY
  • NPI 1336576677
  Medicare reassignment Care Compare group
• Sharon M Colton, MD

  • Family Medicine Physician
  • Evarts, KY
  • NPI 1245264852
  Medicare reassignment NPD
• Kristen Marie Nash, D.O., M.P.H.

  • Family Medicine Physician
  • Harlan, KY
  • NPI 1609308618
  Medicare reassignment NPD
• Jessica Nichole Turner, FNP-C

  • Family Nurse Practitioner
  • Evarts, KY
  • NPI 1639776990
  Medicare reassignment NPD
• William Morgan Miller, PA

  • Medical Physician Assistant
  • Evarts, KY
  • NPI 1720070089
  Medicare reassignment

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542585600000",
    "number": "1811939366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 CHAD ST",
            "address_2": "PO BOX39",
            "city": "EVARTS",
            "state": "KY",
            "postal_code": "408288200",
            "telephone_number": "606-837-2108",
            "fax_number": "606-837-9389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 CHAD ST",
            "address_2": "CLOVER FORK CLINIC",
            "city": "EVARTS",
            "state": "KY",
            "postal_code": "408288200",
            "telephone_number": "606-837-2108",
            "fax_number": "606-837-9389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVER FORK OUTPATIENT MEDICAL PROJECT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2018-11-19",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "BRITT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "606-837-2108",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "KY",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "KY",
            "license": "700006",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100323670",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31000045",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Guadalupe Blas III, LPCC
• Melanie Buchanan-Manning
• Clover Fork Outpatient Medical Project Inc (Clover Fork Clinical Pharmacy)
• Sharon M Colton, MD
• Cumberland Valley Dist. Health Dept.
• Discreet Therapy Services LLC.
• Rachel R Eubank, MD
• Barbara Kaye Middleton, APRN, FNP

• Federally Qualified Health Center (FQHC) in Evarts, KY
• Providers in Evarts, KY by specialty
• Federally Qualified Health Center (FQHC) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.