NPIMap

Organization Active NPI

Regional Health Care Affiliates Inc

  • Family Medicine Physician
  • Henderson, KY
National Provider Identifier
1851767461
Registry record updated Feb 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
700211 Issued in KY
Legal business name
REGIONAL HEALTH CARE AFFILIATES INC
Practice address
700 Martin Luther King Ave
Henderson, KY 42420-3663
Phone
(270) 667-7017
NPI assigned
Aug 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2018

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

Authorized official

Name
Mrs. Shelley Gobin
Title
Ceo
Phone
(270) 667-7017

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 700211 KY Primary

Addresses

Primary practice location

700 Martin Luther King Ave
Henderson, KY 42420-3663

Mailing address

PO Box 37
Providence, KY 42450-0037
Phone (270) 667-7017

Other identifiers 1

IdentifierTypeStateIssuer
7100111220MedicaidKY

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100824000119 KY Part B Supplier - Clinic/Group Practice 3173668274 Receives reassigned benefits from 40 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clay, KY; Providence, KY; Princeton, KY; Owensboro, KY; Morganfield, KY; Henderson, KY; Earlington, KY; Calhoun, KY
O20160617001572 KY Part A Provider - Federally Qualified Health Center (FQHC) 3173668274 Practice locations: Henderson, KY

Federally qualified health center certification: CCN 181963

Legal name
REGIONAL HEALTH CARE AFFILIATES, INC
Doing business as
CABELL PLATT MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 2016
Last certification
Jul 1, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 29, 1982 in KY
Enrollment address
700 Martin Luther King Jr Ave
Henderson, KY 42420-3663

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 8

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
18D2101729Cabell Platt Medical Center700 Martin Luther King Jr Ave, Henderson, KY 42420Certificate of waiverSep 8, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Myra Braden Individual Corporate DirectorBoard Member Nov 25, 2015
Shelley Gobin Individual Corporate OfficerInterim Ceo Jan 1, 2018
W-2 Managing Employee Jan 1, 2018
Vanessa Torres Individual Corporate DirectorBoard Member Nov 25, 2015
Sharon Steedley Individual Corporate DirectorBoard Member Nov 25, 2015
Anthony Dotson Individual Corporate DirectorBoard Member Nov 25, 2015
Monte D Davenport Individual Corporate DirectorBoard Member Nov 25, 2015
Allen Rudd Individual Corporate DirectorBoard Member Nov 25, 2015

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1439856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518393600000",
    "number": "1851767461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37",
            "city": "PROVIDENCE",
            "state": "KY",
            "postal_code": "424500037",
            "telephone_number": "270-667-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 MARTIN LUTHER KING AVE",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424203663",
            "telephone_number": "270-667-7017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL HEALTH CARE AFFILIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-18",
        "last_updated": "2018-02-12",
        "status": "A",
        "authorized_official_last_name": "GOBIN",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "270-667-7017",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "700211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100111220",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, KY

Sources for this page

Verify at the official NPI Registry.