NPIMap

Organization Active NPI

Crittenden Community Hospital LLC

Doing business as Fredonia Family Care

  • Rural Health Clinic/Center
  • Fredonia, KY
National Provider Identifier
1841933496
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CRITTENDEN COMMUNITY HOSPITAL LLC
Doing business as
Fredonia Family Care
Practice address
21234 Marion Rd
Fredonia, KY 42411-9250
Phone
(270) 545-2929
NPI assigned
Apr 20, 2022
Last updated
Mar 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

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

Authorized official

Name
Darrel Morris
Title
Coo
Phone
(918) 527-1234

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

21234 Marion Rd
Fredonia, KY 42411-9250

Mailing address

520 W Gum St
Marion, KY 42064-1516
Phone (270) 965-1042

Other names 1

  • Fredonia Family Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190606001972 KY Part B Supplier - Clinic/Group Practice 8426398793 Receives reassigned benefits from 30 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fredonia, KY; Marion, KY; Sturgis, KY
O20220606002938 KY Part A Provider - Rural Health Clinic 8426398793 Practice locations: Fredonia, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841933496. Details of each certification follow.

Rural health clinic certification: CCN 188555

Legal name
CRITTENDEN COMMUNITY HOSPITAL LLC
Doing business as
FREDONIA FAMILY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 18, 2023
Last certification
Jan 18, 2023
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Oct 9, 2018 in KY
Enrollment address
21234 Marion Rd
Fredonia, KY 42411-9250
Related CCNs
180095

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 2

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
18D2260502Crittenden Community Hospital Fredonia21234 Marion Rd, Fredonia, KY 42411Provider-performed microscopyJun 20, 2028

National Provider Directory

National Provider Directory
Tax ID family
Crittenden Community Hospital LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Darrel W Morris Individual 5% Or Greater Indirect Ownership InterestCoo & Board Member Jan 4, 2021 17.25%
Corporate OfficerCoo & Board Member Jan 4, 2021 17.25%
Corporate DirectorCoo & Board Member Jan 4, 2021 17.25%
Operational/Managerial ControlCoo & Board Member Jan 4, 2021 17.25%
RHG Consolidated LLC Organization, Kansas City, MO LLC, Management services company, For-profit 5% Or Greater Direct Ownership Interest Jan 4, 2021 100%
Operational/Managerial Control Jan 4, 2021 100%
Lawrence J Arthur Individual 5% Or Greater Indirect Ownership Interest Jan 4, 2021 17.71%
Trent M Skaggs Individual 5% Or Greater Indirect Ownership InterestPresident & Board Member Jan 4, 2021 17.71%
Corporate OfficerPresident & Board Member Jan 4, 2021 17.71%
Corporate DirectorPresident & Board Member Jan 4, 2021 17.71%
Operational/Managerial ControlPresident & Board Member Jan 4, 2021 17.71%
LG Medical LLC Organization, Kansas City, MO LLC, Medical provider/supplier, Investment firm, For-profit 5% Or Greater Indirect Ownership Interest Jan 4, 2021 11.27%
Brent Lagergren Individual 5% Or Greater Indirect Ownership Interest Jan 4, 2021 6.27%
Corporate OfficerVP & Chief Compliance Officer Jan 4, 2021 6.27%
Billy W May Individual 5% Or Greater Indirect Ownership InterestVP & Board Member Jan 4, 2021 5.81%
Corporate OfficerVP & Board Member Jan 4, 2021 5.81%
Corporate DirectorVP & Board Member Jan 4, 2021 5.81%
Operational/Managerial ControlVP & Board Member Jan 4, 2021 5.81%
Dennis L Davis Individual 5% Or Greater Indirect Ownership Interest Jan 4, 2021 17.71%
Paul Guastello Individual 5% Or Greater Indirect Ownership Interest Jan 4, 2021 11.27%

Facilities with the same owner 11

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

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1650412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677628800000",
    "number": "1841933496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 W GUM ST",
            "city": "MARION",
            "state": "KY",
            "postal_code": "420641516",
            "telephone_number": "270-965-1042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21234 MARION RD",
            "city": "FREDONIA",
            "state": "KY",
            "postal_code": "424119250",
            "telephone_number": "270-545-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRITTENDEN COMMUNITY HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-20",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "DARREL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "918-527-1234"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fredonia Family Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fredonia Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fredonia, KY

Sources for this page

Verify at the official NPI Registry.