NPIMap

Organization Active NPI

Hope Primary & Urgent Care of Williamsburg PLLC

  • Rural Health Clinic/Center
  • Williamsburg, KY
National Provider Identifier
1851058028
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HOPE PRIMARY & URGENT CARE OF WILLIAMSBURG PLLC
Practice address
896 S Highway 25W
Williamsburg, KY 40769
Phone
(606) 515-6124
Fax
(606) 515-6163
NPI assigned
Nov 23, 2021
Last updated
Sep 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Authorized official

Name
James Carroll CorderNPI 1700227147
Title
Owner
Phone
(606) 515-6124

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X

Addresses

Primary practice location

896 S Highway 25W
Williamsburg, KY 40769

Mailing address

PO Box 68
Stearns, KY 42647-0068

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220316002497 KY Part B Supplier - Clinic/Group Practice 9739574468 Receives reassigned benefits from 19 practitioners
Practice locations: Williamsburg, KY
O20220923002227 KY Part A Provider - Rural Health Clinic 9739574468 Practice locations: Williamsburg, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851058028. Details of each certification follow.

Rural health clinic certification: CCN B03918

Legal name
HOPE PRIMARY & URGENT CARE OF WILLIAMSBURG PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 15, 2023
Last certification
May 15, 2023
Ownership / control type
1A
Organization structure
LLCProprietary
Enrollment address
896 S Highway 25 W
Williamsburg, KY 40769-1691

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
18D2255095Hope Primary + Urgent Care of Williamsburg PLLC896 S Highway 25 W, Williamsburg, KY 40769Certificate of waiverMar 9, 2028

National Provider Directory

National Provider Directory

Locations

896 S Highway 25 W
Williamsburg, KY 40769
Phone (606) 376-9700

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
James Carroll Corder Individual 5% Or Greater Direct Ownership Interest May 1, 2022 100%
Corporate OfficerManaging Member Aug 1, 2021
Stephanie Slaven Individual W-2 Managing EmployeeOffice Manager May 1, 2023 100%

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 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1637625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727654400000",
    "number": "1851058028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 68",
            "city": "STEARNS",
            "state": "KY",
            "postal_code": "426470068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "896 S HIGHWAY 25W",
            "city": "WILLIAMSBURG",
            "state": "KY",
            "postal_code": "40769",
            "telephone_number": "606-515-6124",
            "fax_number": "606-515-6163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOPE PRIMARY & URGENT CARE OF WILLIAMSBURG PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-23",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "CORDER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "CARROLL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-515-6124"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsburg, KY

Sources for this page

Verify at the official NPI Registry.