NPIMap

Organization Active NPI

T J Health Columbia Inc

Doing business as T J Health Edmonton

  • Rural Health Clinic/Center
  • Edmonton, KY
National Provider Identifier
1831555358
Registry record updated Mar 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
T J HEALTH COLUMBIA INC
Doing business as
T J Health Edmonton
Practice address
1704 W Stockton St
Edmonton, KY 42129-8137
Phone
(270) 432-4800
Fax
(270) 432-4804
NPI assigned
Jan 13, 2016
Last updated
Mar 30, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
T J REGIONAL HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 30, 2023

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

Authorized official

Name
Neil Thornbury
Title
Ceo
Phone
(270) 651-4159

Specialties & licenses 1

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

Addresses

Primary practice location

1704 W Stockton St
Edmonton, KY 42129-8137

Mailing address

PO Box 654996
Cincinnati, OH 45264-0001
Phone (270) 651-4444

Other identifiers 1

IdentifierTypeStateIssuer
7100422700MedicaidKY

Other names 1

  • T J Health Edmonton Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160324002277 KY Part A Provider - Rural Health Clinic 7113224783 Practice locations: Edmonton, KY
O20161004002436 KY Part B Supplier - Clinic/Group Practice 7113224783 Receives reassigned benefits from 9 practitioners
Practice locations: Edmonton, KY; Columbia, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831555358. Details of each certification follow.

Rural health clinic certification: CCN 183994

Legal name
T J HEALTH COLUMBIA INC
Doing business as
T J HEALTH EDMONTON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 18, 1994
Last certification
Jun 1, 2017
Ownership / control type
2B
Most recent change of ownership
Feb 11, 2016 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Dec 15, 2015 in KY
Enrollment address
1704 W Stockton St
Edmonton, KY 42129-8137
Related CCNs
180149

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

Other NPIs with the same Medicare PAC ID 9

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

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
18D1002314T J Health Edmonton1704 West Stockton Street, Edmonton, KY 42129Certificate of waiverOct 9, 2026

National Provider Directory

National Provider Directory
Tax ID family
T J Health Columbia Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Thomas Rich Alexander Individual Corporate DirectorBoard Member Dec 15, 2015
Ladonna G Rogers Individual Corporate OfficerEvp / Human Resources Jan 1, 2021
W-2 Managing EmployeeEvp / Humana Resources Dec 15, 2015
Stacey Biggs Individual Corporate OfficerEvp / Marketing Jan 1, 2021
Neil C Thornbury Individual Corporate OfficerCeo Jan 1, 2021
W-2 Managing EmployeeCeo Dec 15, 2015
Jodie Holgate Individual Corporate OfficerEvp / Patient Care Services Jan 1, 2021
Bo Matthews Individual Corporate DirectorBoard Member Jan 1, 2021
TJ Regional Health Inc Organization, Glasgow, KY Non-profit 5% Or Greater Direct Ownership Interest Dec 15, 2015 100%
Ervin Sorrell Individual Corporate DirectorBoard Member Jan 1, 2021
Michael S Young Individual Corporate DirectorBoard Member Dec 15, 2015
Brent Billingsley Individual Corporate DirectorBoard Member Jan 1, 2021
Brandon Dickey Individual Corporate OfficerEvp / Cno Jan 1, 2021
James Lee Individual Corporate OfficerEvp / Support Services Jan 1, 2021
W-2 Managing EmployeeEvp / Support Services Nov 1, 2016
Michael Bryant Individual Corporate DirectorBoard Member Dec 15, 2015
Mei Deng Individual Corporate OfficerCfo Jan 1, 2021
Rollin Underwood Individual Corporate DirectorBoard Member Dec 15, 2015
Christy Biggerstaff Individual W-2 Managing EmployeeBusiness Office Director Jan 1, 2021
Karen Small Individual Corporate DirectorBoard Member Dec 15, 2015
Michael Andrew Saridakis Individual Corporate DirectorBoard Member Jan 1, 2022
Daniel Foutch Individual Corporate DirectorBoard Member Dec 15, 2015
Jennifer Cerwinske Individual Corporate OfficerEvp / Practice Management Jan 1, 2021
Joseph Botts Individual Corporate DirectorBoard Member Dec 15, 2015
Henry Royse Individual Corporate DirectorBoard Member Dec 15, 2015
Kylend Hollie Kiser Individual Corporate DirectorBoard Member Jan 1, 2022

Owners & managing parties with NPI records 2

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

Facilities with the same owner 12

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

Change-of-ownership history 1

DateEventCounterparty
Feb 11, 2016 Change of OwnershipThis provider was the buyer Edmonton Primary CareCCN 183994, KY, NPI 1699740647

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 55

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 55

NPI Registry JSON

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

{
    "created_epoch": "1452643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680134400000",
    "number": "1831555358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 654996",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452640001",
            "telephone_number": "270-651-4444",
            "fax_number": "270-651-4892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 W STOCKTON ST",
            "city": "EDMONTON",
            "state": "KY",
            "postal_code": "421298137",
            "telephone_number": "270-432-4800",
            "fax_number": "270-432-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "T J HEALTH COLUMBIA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "T J REGIONAL HEALTH INC",
        "enumeration_date": "2016-01-13",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A",
        "authorized_official_last_name": "THORNBURY",
        "authorized_official_first_name": "NEIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "270-651-4159"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100422700",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "T J Health Edmonton",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "T J Health Edmonton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edmonton, KY

Sources for this page

Verify at the official NPI Registry.