NPIMap

Organization Active NPI

Casey County Hospital District

Doing business as Casey County Primary Care

  • Rural Health Clinic/Center
  • Liberty, KY
National Provider Identifier
1871567362
Registry record updated Feb 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
900075 Issued in KY
Legal business name
CASEY COUNTY HOSPITAL DISTRICT
Doing business as
Casey County Primary Care
Practice address
187 Wolford Ave
Liberty, KY 42539-3187
Phone
(606) 787-6275
Fax
(606) 787-8925
NPI assigned
Feb 14, 2006
Last updated
Feb 23, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2017

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

Authorized official

Name
Rex A. Tungate
Title
Ceo Adminstrator
Phone
(270) 403-0732

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 900075 KY Primary

Addresses

Primary practice location

187 Wolford Ave
Liberty, KY 42539-3187

Mailing address

187 Wolford Ave
Liberty, KY 42539-3187
Phone (606) 787-6275

Other identifiers 1

IdentifierTypeStateIssuer
65909897MedicaidKY

Other names 1

  • Casey County Primary 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
O20031110000044 KY Part B Supplier - Clinic/Group Practice 0749193423 Receives reassigned benefits from 29 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Liberty, KY
O20071207000184 KY Part A Provider - Rural Health Clinic 0749193423 Practice locations: Liberty, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871567362. Details of each certification follow.

Rural health clinic certification: CCN 183428

Legal name
CASEY COUNTY HOSPITAL DISTRICT
Doing business as
CASEY COUNTY PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 24, 1997
Last certification
Feb 15, 2017
Ownership / control type
2B
Most recent change of ownership
Sep 15, 2003 (1 total)
Organization structure
OtherNon-profit
Enrollment address
195 N Wallace Wilkinson Blvd
Ste a
Liberty, KY 42539-3013
Related CCNs
181309

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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
18D0922493Casey County Primary Care195 North Wallace Wilkinson Blvd, Liberty, KY 42539Certificate of waiverNov 25, 2026

National Provider Directory

National Provider Directory
Tax ID family
Casey County Primary Care Nursing Group8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Casey County Hospital District Organization, Liberty, KY 5% Or Greater Direct Ownership Interest Nov 19, 2007 100%
Rex Tungate Individual Corporate OfficerCeo Nov 17, 2007
W-2 Managing Employee Nov 15, 2016
Tungate Healthcare Enterprises Inc Organization, Campbellsville, KY Management services company Operational/Managerial Control Nov 17, 2007
Edward a Wesley Individual Corporate DirectorDirector Sep 10, 2024
Karen Atwood Individual Corporate DirectorSecretary/Treasurer May 10, 2011
Ronald Wright Individual Corporate DirectorChairman Feb 1, 2018
Robert T Rousey Individual Corporate DirectorDirector Oct 13, 2015
Dan Johnson Individual Corporate DirectorDirector Nov 1, 2019

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Casey County Hospital DistrictLiberty, KY, CCN 181309 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2007
Casey County Hospital Swing Bed UnitLiberty, KY, CCN 18Z309 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 19, 2007
Casey County Family PracticeLiberty, KY, CCN 183466 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 29, 2009

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1139875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487808000000",
    "number": "1871567362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "187 WOLFORD AVE",
            "city": "LIBERTY",
            "state": "KY",
            "postal_code": "425393187",
            "telephone_number": "606-787-6275",
            "fax_number": "606-787-8925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 WOLFORD AVE",
            "city": "LIBERTY",
            "state": "KY",
            "postal_code": "425393187",
            "telephone_number": "606-787-6275",
            "fax_number": "606-787-8925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASEY COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-14",
        "last_updated": "2017-02-23",
        "status": "A",
        "authorized_official_last_name": "TUNGATE",
        "authorized_official_first_name": "REX",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CEO ADMINSTRATOR",
        "authorized_official_telephone_number": "270-403-0732"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65909897",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Casey County Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Liberty, KY

Sources for this page

Verify at the official NPI Registry.