NPIMap

Organization Active NPI

Juniper Health Inc

Doing business as Juniper Health Jackon City School

  • Federally Qualified Health Center (FQHC)
  • Jackson, KY
National Provider Identifier
1821876483
Registry record updated Sep 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JUNIPER HEALTH INC
Doing business as
Juniper Health Jackon City School
Practice address
940 Highland Ave
Jackson, KY 41339-1124
Phone
(606) 464-0151
NPI assigned
Sep 15, 2023
Last updated
Sep 15, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
JUNIPER HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 15, 2023

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

Authorized official

Name
Derrick J Hamilton, DONPI 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 Primary

Addresses

Primary practice location

940 Highland Ave
Jackson, KY 41339-1124

Mailing address

PO Box 690
Beattyville, KY 41311-0690
Phone (606) 464-0151

Other identifiers 1

IdentifierTypeStateIssuer
31000862MedicaidKY

Other names 1

  • Juniper Health Jackon City School Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050214000128 KY Part B Supplier - Clinic/Group Practice 2961453618 Receives reassigned benefits from 25 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Liberty, KY; Sandy Hook, KY; Rogers, KY; Jackson, KY; Campton, KY; Frenchburg, KY; Hazel Green, KY; Beattyville, KY…
O20231220000993 KY Part A Provider - Federally Qualified Health Center (FQHC) 2961453618 Practice locations: Jackson, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821876483. Details of each certification follow.

Federally qualified health center certification: CCN B01111

Legal name
JUNIPER HEALTH INC
Doing business as
JUNIPER HEALTH JACKSON CITY SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 14, 2023
Last certification
Dec 14, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 23, 2003 in KY
Enrollment address
940 Highland Ave
Jackson, KY 41339-1124

Other NPIs with the same Medicare PAC ID 16

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

  • Juniper Health Inc

    dba Juniper Health Rogers Elementary School

    • Federally Qualified Health Center (FQHC)
    • Rogers, KY
    • NPI 1114705944

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Breathitt Elementary

    • Federally Qualified Health Center (FQHC)
    • Jackson, KY
    • NPI 1124807177

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Breathitt High School

    • Federally Qualified Health Center (FQHC)
    • Jackson, KY
    • NPI 1164201117

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Lee County Family Medical Clinic

    • Federally Qualified Health Center (FQHC)
    • Beattyville, KY
    • NPI 1407818628

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Menifee County

    • Federally Qualified Health Center (FQHC)
    • Frenchburg, KY
    • NPI 1447037122

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Morgan County

    • Federally Qualified Health Center (FQHC)
    • West Liberty, KY
    • NPI 1447791512

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Breathitt County Family Health Center

    • Federally Qualified Health Center (FQHC)
    • Jackson, KY
    • NPI 1467417691

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Sebastian Elementary School

    • Federally Qualified Health Center (FQHC)
    • Jackson, KY
    • NPI 1528847670

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Red River Elementary School

    • Federally Qualified Health Center (FQHC)
    • Hazel Green, KY
    • NPI 1609654276

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Wolfe County Middle School

    • Federally Qualified Health Center (FQHC)
    • Campton, KY
    • NPI 1619755287

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Elliott County

    • Federally Qualified Health Center (FQHC)
    • Sandy Hook, KY
    • NPI 1669014627

    2961453618

    Same PAC ID
  • Juniper Health Inc

    dba Juniper Health Lee County Middle High School

    • Federally Qualified Health Center (FQHC)
    • Beattyville, KY
    • NPI 1679354898

    2961453618

    Same PAC ID
View all 16

Other NPIs on the same Medicare enrollment 16

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

View all 16

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
18D2295434Juniper Health Jackson City School940 Highland Avenue, Jackson, KY 41339Certificate of waiverDec 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
Juniper Health Inc15 organizations share this tax ID, including this one
Part of
Juniper Health Inc

Other organizations with this tax ID 14

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

  • Juniper Health Inc

    dba Juniper Health Rogers Elementary School

    • Federally Qualified Health Center (FQHC)
    • Rogers, KY
    • NPI 1114705944
    NPD tax ID
  • Juniper Health Inc

    dba Juniper Health Breathitt Elementary

    • Federally Qualified Health Center (FQHC)
    • Jackson, KY
    • NPI 1124807177
    NPD tax ID
  • Juniper Health Inc

    dba Juniper Health Breathitt High School

    • Federally Qualified Health Center (FQHC)
    • Jackson, KY
    • NPI 1164201117
    NPD tax ID
  • Juniper Health Inc

    dba Juniper Health Menifee County

    • Federally Qualified Health Center (FQHC)
    • Frenchburg, KY
    • NPI 1447037122
    NPD tax ID
  • Juniper Health Inc

    dba Juniper Morgan County

    • Federally Qualified Health Center (FQHC)
    • West Liberty, KY
    • NPI 1447791512
    NPD tax ID
  • Juniper Health Inc

    dba Juniper Health Sebastian Elementary School

    • Federally Qualified Health Center (FQHC)
    • Jackson, KY
    • NPI 1528847670
    NPD tax ID
  • Juniper Health Inc

    dba Juniper Health Red River Elementary School

    • Federally Qualified Health Center (FQHC)
    • Hazel Green, KY
    • NPI 1609654276
    NPD tax ID
  • Juniper Health Inc

    dba Juniper Health Wolfe County Middle School

    • Federally Qualified Health Center (FQHC)
    • Campton, KY
    • NPI 1619755287
    NPD tax ID
  • Juniper Health Inc

    dba Juniper Health Elliott County

    • Federally Qualified Health Center (FQHC)
    • Sandy Hook, KY
    • NPI 1669014627
    NPD tax ID
  • Juniper Health Inc

    dba Juniper Health Lee County Middle High School

    • Federally Qualified Health Center (FQHC)
    • Beattyville, KY
    • NPI 1679354898
    NPD tax ID
  • Juniper Health Inc

    dba Juniper Health Highland-Turner Elementary

    • Federally Qualified Health Center (FQHC)
    • Booneville, KY
    • NPI 1750160123
    NPD tax ID
  • Juniper Health Inc

    dba Juniper Heatlh Lee County Elementary

    • Federally Qualified Health Center (FQHC)
    • Beattyville, KY
    • NPI 1871374090
    NPD tax ID
View all 14

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 Jul 1, 2021
Lisa Stamper Individual Corporate OfficerBoard Secretary Jan 1, 2011
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 Treasuer 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 Jul 1, 2020

Owners & managing parties with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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": "1694736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694736000000",
    "number": "1821876483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690",
            "city": "BEATTYVILLE",
            "state": "KY",
            "postal_code": "413110690",
            "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": "940 HIGHLAND AVE",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413391124",
            "telephone_number": "606-464-0151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUNIPER HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JUNIPER HEALTH INC",
        "enumeration_date": "2023-09-15",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-14",
        "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"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31000862",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Juniper Health Jackon City School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, KY

Sources for this page

Verify at the official NPI Registry.