NPIMap

Organization Active NPI

First You Medical Center PLLC

  • Rural Health Clinic/Center
  • Bedford, KY
National Provider Identifier
1841358876
Registry record updated Nov 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
900263 Issued in KY
Legal business name
FIRST YOU MEDICAL CENTER PLLC
Practice address
18 Alexander Ave
Unit 1
Bedford, KY 40006-1114
Phone
(502) 255-0222
Fax
(888) 310-2675
NPI assigned
Dec 4, 2006
Last updated
Nov 27, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2015

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

Authorized official

Name
Shanna Stivers Dave
Title
Member/Owner
Phone
(502) 593-0083

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 900263 KY Primary
Physician Assistant 363A00000X KY
Family Nurse Practitioner 363LF0000X NU
Family Medicine Physician 207Q00000X KY

Addresses

Primary practice location

18 Alexander Ave
Unit 1
Bedford, KY 40006-1114

Mailing address

PO Box 124
Eminence, KY 40019-0124
Phone (502) 593-0083

Other identifiers 6

IdentifierTypeStateIssuer
000000265566OtherKYANTHEM
2443866001OtherKYPASSPORT ADVANTAGE
50002355OtherKYPASSPORT HEALTH
CK7832OtherKYRAILROAD MEDICARE
7100244880MedicaidKY
64127467OtherKYPHP

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130320000373 KY Part A Provider - Rural Health Clinic 4688572464 Practice locations: Bedford, KY
O20130725000332 KY Part B Supplier - Clinic/Group Practice 4688572464 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bedford, KY; Eminence, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841358876. Details of each certification follow.

Rural health clinic certification: CCN 188922

Legal name
FIRST YOU MEDICAL CENTER PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 3, 2013
Last certification
Apr 25, 2013
Ownership / control type
2B
Organization structure
LLCProprietary
Incorporated
Nov 13, 2000 in KY
Enrollment address
18 Alexander Ave
# 1
Bedford, KY 40006-1114

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

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
18D1021465First You Medical Center PLLC - Bedford Office18 Alexander Avenue Unit One, Bedford, KY 40006Certificate of waiverJul 27, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Shanna Stivers Dave Individual 5% Or Greater Direct Ownership InterestOwner Oct 22, 2015 100%
Corporate OfficerOwner Oct 22, 2015
Corporate DirectorOwner Oct 22, 2015
W-2 Managing EmployeeManager/Owner Oct 22, 2015
Operational/Managerial ControlMember/Owner Oct 22, 2015

Owners & managing parties with NPI records 1

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

  • Shanna Stivers Dave, APRN-CNP PMHNP-BC
    • Psychiatric/Mental Health Nurse Practitioner
    • Bedford, KY
    • NPI 1598591075

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 11

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": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448582400000",
    "number": "1841358876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 124",
            "city": "EMINENCE",
            "state": "KY",
            "postal_code": "400190124",
            "telephone_number": "502-593-0083",
            "fax_number": "888-310-2675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 ALEXANDER AVE",
            "address_2": "UNIT 1",
            "city": "BEDFORD",
            "state": "KY",
            "postal_code": "400061114",
            "telephone_number": "502-255-0222",
            "fax_number": "888-310-2675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST YOU MEDICAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2015-11-27",
        "status": "A",
        "authorized_official_last_name": "STIVERS DAVE",
        "authorized_official_first_name": "SHANNA",
        "authorized_official_title_or_position": "MEMBER/OWNER",
        "authorized_official_telephone_number": "502-593-0083"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900263",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000265566",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT ADVANTAGE",
            "identifier": "2443866001",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT HEALTH",
            "identifier": "50002355",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CK7832",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100244880",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "64127467",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bedford, KY

Sources for this page

Verify at the official NPI Registry.