NPIMap

Organization Active NPI

Mountain Comprehensive Health Corporation

  • Primary Care Clinic/Center
  • Jeremiah, KY
National Provider Identifier
1821546573
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Practice address
105 Isom PLZ
Jeremiah, KY 41826-9088
Phone
(606) 633-2233
Fax
(606) 633-2223
NPI assigned
Sep 12, 2016
Last updated
Oct 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

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

Authorized official

Name
L.M. (Mike) Caudill
Title
Chief Executive Officer
Phone
(606) 633-4823

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Federally Qualified Health Center (FQHC) 261QF0400X
Primary Care Clinic/Center 261QP2300X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

105 Isom PLZ
Jeremiah, KY 41826-9088

Mailing address

PO Box 40
Whitesburg, KY 41858-0040
Phone (606) 633-4823

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031224000024 KY Part B Supplier - Clinic/Group Practice 7618875873 Receives reassigned benefits from 92 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jeremiah, KY; Whitesburg, KY; Pineville, KY; Middlesboro, KY; Hindman, KY; Harlan, KY; Elkhorn City, KY; Cumberland, KY…
O20161021002118 KY Part A Provider - Federally Qualified Health Center (FQHC) 7618875873 Practice locations: Jeremiah, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821546573. Details of each certification follow.

Federally qualified health center certification: CCN 181986

Legal name
MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
Doing business as
ISOM MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 28, 2016
Last certification
Sep 28, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 14, 1972 in KY
Enrollment address
105 Isom PLZ
Jeremiah, KY 41826-9088

Other NPIs with the same Medicare PAC ID 24

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

View all 24

Other NPIs on the same Medicare enrollment 13

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

View all 13

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
18D2032974MCHC Isom Medical Clinic105 Isom Plaza, Jeremiah, KY 41826Certificate of waiverNov 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
MTN Comprehensive HLTH35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Locations

464 KY Highway 699
Cornettsville, KY 41731
Phone (606) 476-2450

132 Village Center Rd
Harlan, KY 40831
Phone (606) 573-2004

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Sherry Childers Individual Corporate DirectorBoard Treasurer Jan 1, 2024
Steve Peake Individual Corporate DirectorBoard Member Jul 20, 2022
William Parks Individual Corporate DirectorBoard Member Jan 1, 2018
Jerry Hall Individual Corporate DirectorBoard Member Jan 1, 2022
Mike Caudill Individual Corporate OfficerChief Executive Officer Jul 1, 2005
David Adams Individual Corporate DirectorBoard Member Jan 1, 2024
Teresa Dotson Individual Corporate OfficerChief Operating Officer Sep 8, 2025
W-2 Managing EmployeeChief Operating Officer Sep 8, 2025
Charles Colwell Individual Corporate DirectorBoard Member Jan 1, 2025
Gwen Johnson Individual Corporate DirectorBoard Member Jan 1, 2025
Jackie Colwell Individual Corporate DirectorBoard Member Jan 1, 2019
Teresa Hunter Individual Corporate DirectorBoard Member Jan 1, 2025
Mary Ann Sparks Individual Corporate DirectorBoard Member Jan 1, 2020
Paul Pratt Individual Corporate DirectorChairman of the Board Jan 1, 2023
Nanette Banks Individual Corporate DirectorBoard Secretary Jan 1, 2023
Robert Musick Individual Corporate DirectorBoard Member Sep 17, 2024
Carlana G. Mullins Individual Corporate DirectorBoard Member Jan 1, 2013
Kathy Hall Individual Corporate DirectorVice-Chairman of the Board Jan 1, 2024

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Mountain Comprehensive Health CorporationWhitesburg, KY, CCN 181893 Federally qualified health center Operational/Managerial Control Aug 1, 2012
Letcher County Alternative Education School Based ClinicWhitesburg, KY, CCN 181892 Federally qualified health center Operational/Managerial Control Aug 1, 2012
Mountain Comprehensive Health CorporationLetcher, KY, CCN 181891 Federally qualified health center Operational/Managerial Control Aug 1, 2012
Mountain Comprehensive Health CorporationWhitesburg, KY, CCN 181894 Federally qualified health center Operational/Managerial Control Aug 1, 2012

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1473638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1821546573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "WHITESBURG",
            "state": "KY",
            "postal_code": "418580040",
            "telephone_number": "606-633-4823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 ISOM PLZ",
            "city": "JEREMIAH",
            "state": "KY",
            "postal_code": "418269088",
            "telephone_number": "606-633-2233",
            "fax_number": "606-633-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN COMPREHENSIVE HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-12",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A",
        "authorized_official_last_name": "CAUDILL",
        "authorized_official_first_name": "L.M. (MIKE)",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "606-633-4823"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jeremiah, KY

Sources for this page

Verify at the official NPI Registry.