NPIMap

Organization Active NPI

Breckinridge Health Inc.

Doing business as Breckinridge Health ENT

  • Otolaryngology Physician
  • Hardinsburg, KY
National Provider Identifier
1831674811
Registry record updated Sep 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
BRECKINRIDGE HEALTH INC.
Doing business as
Breckinridge Health ENT
Practice address
107 Old Highway 60
Hardinsburg, KY 40143-2501
Phone
(270) 580-2250
Fax
(270) 580-2273
NPI assigned
Sep 26, 2018
Last updated
Sep 26, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
BRECKINRIDGE HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 26, 2018

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

Authorized official

Name
Joan Carman
Title
Credentialing Contact
Phone
(270) 756-6564

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

107 Old Highway 60
Hardinsburg, KY 40143-2501

Mailing address

1011 Old Highway 60
Hardinsburg, KY 40143-2519
Phone (270) 756-6564

Other names 1

  • Breckinridge Health ENT Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031208000333 KY Part B Supplier - Clinic/Group Practice 0941106454 Receives reassigned benefits from 32 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hardinsburg, KY; McDaniels, KY; Irvington, KY; Cloverport, KY
O20071018000547 KY Part A Provider - Critical Access Hospital 0941106454 Receives reassigned benefits from 11 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hardinsburg, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831674811. Details of each certification follow.

Hospital certification: CCN 181319

Legal name
BRECKINRIDGE HEALTH, INC.
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 1, 2003
Last certification
Nov 29, 2012
Beds
25
Ownership / control type
Local
Organization structure
CorporationNon-profit
Incorporated
Nov 24, 1947 in KY
Enrollment address
1011 Old Highway 60
Hardinsburg, KY 40143-2519
Main/Primary Hospital Location

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

Other NPIs on the same Medicare enrollment 9

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Breckinridge Memorial HospitalCCN 181319 · All quality measures
Overall star rating
1 of 5
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Breckinridge Health Inc21 organizations share this tax ID, including this one
Part of
Breckinridge Health Inc

Other organizations with this tax ID 20

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

View all 20

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Amy Arndell Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2019 5%
Corporate OfficerCfo Jan 1, 2020
Rebecca Pollock Individual Corporate Officer Aug 1, 2020
Dottie Watson Individual Corporate DirectorBoard MBR Apr 1, 1999
Faye Dowell Individual Corporate DirectorBoard Member Jan 1, 2019
Jeffrey Robbins Individual Corporate DirectorBoard MBR Feb 1, 2014
Mitchell Jackson Individual Corporate Officer Feb 1, 2020
Holly Gregory Individual Corporate DirectorBoard Member Jan 1, 2019
Tom Loughran Individual Corporate DirectorBoard Member Jun 1, 2019
Sherry Wilson Individual Corporate Officer Jun 1, 2022
Angela Portman Individual Corporate OfficerCeo Jun 1, 2015
Operational/Managerial ControlCeo Jan 1, 2015
Janice Elder Individual Corporate DirectorBoard Member Jan 1, 2020
Kerry Kasey Individual Corporate DirectorBoard Member Jan 1, 2019
Kim Flood Individual Corporate DirectorBoard Member Jan 1, 2020
Layman Lucas Individual Corporate DirectorBoard Member Jan 1, 2019
Melony Jill Jaggers Individual Corporate Officer Jul 1, 2021

Owners & managing parties with NPI records 1

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

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.

Affiliated clinicians 66

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1537920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537920000000",
    "number": "1831674811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 OLD HIGHWAY 60",
            "city": "HARDINSBURG",
            "state": "KY",
            "postal_code": "401432519",
            "telephone_number": "270-756-6564",
            "fax_number": "270-580-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 OLD HIGHWAY 60",
            "city": "HARDINSBURG",
            "state": "KY",
            "postal_code": "401432501",
            "telephone_number": "270-580-2250",
            "fax_number": "270-580-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRECKINRIDGE HEALTH INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRECKINRIDGE HEALTH INC",
        "enumeration_date": "2018-09-26",
        "last_updated": "2018-09-26",
        "status": "A",
        "authorized_official_last_name": "CARMAN",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "CREDENTIALING CONTACT",
        "authorized_official_telephone_number": "270-756-6564"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Breckinridge Health ENT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hardinsburg, KY

Sources for this page

Verify at the official NPI Registry.