NPIMap

Organization Active NPI

Lewis County Primary Care Center, Inc.

Doing business as Bracken County School-based Center

  • Federally Qualified Health Center (FQHC)
  • Brooksville, KY
National Provider Identifier
1871208199
Registry record updated Jan 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LEWIS COUNTY PRIMARY CARE CENTER, INC.
Doing business as
Bracken County School-based Center
Practice address
106 Powell St.
Brooksville, KY 41004
Phone
(606) 402-2075
NPI assigned
Jan 20, 2023
Last updated
Jan 20, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
LEWIS COUNTY PRIMARY CARE CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 20, 2023

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

Authorized official

Name
Chad Erwin Evans
Title
Cco
Phone
(606) 956-0188

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

106 Powell St.
Brooksville, KY 41004

Mailing address

PO Box 550
Vanceburg, KY 41179-0550
Phone (606) 956-0188

Other identifiers 1

IdentifierTypeStateIssuer
31000268MedicaidKY

Other names 1

  • Bracken County School-based Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231024001134 KY Part A Provider - Federally Qualified Health Center (FQHC) 1153311774 Practice locations: Brooksville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871208199. Details of each certification follow.

Federally qualified health center certification: CCN B01097

Legal name
LEWIS COUNTY PRIMARY CARE CENTER, INC
Doing business as
BRACKEN COUNTY SCHOOL BASED CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 6, 2023
Last certification
Oct 6, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 27, 1983 in KY
Enrollment address
106 Powell St
Brooksville, KY 41004

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Lewis County Primary Care Center Inc18 organizations share this tax ID, including this one
Part of
Lewis County Primary Care Center Inc

Other organizations with this tax ID 17

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

View all 17

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Michael Kennedy Individual Corporate Director Apr 14, 2016
Jerry G Ugrin Individual Corporate OfficerCeo Oct 1, 1992
W-2 Managing EmployeeCeo Oct 1, 1992
Edward Connors Individual Corporate Director Sep 10, 2020
Loretta Dixon Individual Corporate Officer Mar 3, 2003
Lindsay Phillips Individual Corporate Officer Oct 9, 2014
Rita Harrison Individual Corporate Officer Feb 8, 2018
Margaret Snedegar Individual Corporate Director Nov 11, 2004
Tara Blevins Individual Corporate Director May 1, 2021
Jeremy Faulkner Individual Corporate Director Nov 14, 2013
Diana Wilson Individual Corporate Director Mar 10, 2016
Joan S Pugh Individual Corporate Officer Dec 1, 2005

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.

NPI Registry JSON

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

{
    "created_epoch": "1674172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674172800000",
    "number": "1871208199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "VANCEBURG",
            "state": "KY",
            "postal_code": "411790550",
            "telephone_number": "606-956-0188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 POWELL ST.",
            "city": "BROOKSVILLE",
            "state": "KY",
            "postal_code": "41004",
            "telephone_number": "606-402-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWIS COUNTY PRIMARY CARE CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEWIS COUNTY PRIMARY CARE CENTER, INC.",
        "enumeration_date": "2023-01-20",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-13",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "ERWIN",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "606-956-0188"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31000268",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bracken County School-based Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooksville, KY

Sources for this page

Verify at the official NPI Registry.