NPIMap

Organization Active NPI

Primary Care Centers of Eastern Kentucky, LLC

Doing business as Primary Care Centers of Eastern Kentucky-Hazard

  • Rural Health Clinic/Center
  • Hazard, KY
National Provider Identifier
1942275805
Registry record updated Sep 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
900161 Issued in KY
Legal business name
PRIMARY CARE CENTERS OF EASTERN KENTUCKY, LLC
Doing business as
Primary Care Centers of Eastern Kentucky-Hazard
Practice address
101 Town and Country LN
Suite100
Hazard, KY 41701-9524
Phone
(606) 439-1300
Fax
(606) 439-1400
NPI assigned
Feb 22, 2006
Last updated
Sep 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2016

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

Authorized official

Name
Mr. Barry Martin
Title
Ceo
Phone
(606) 439-1300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 900161 KY Primary

Addresses

Primary practice location

101 Town and Country LN
Suite100
Hazard, KY 41701-9524

Mailing address

PO Box 1988
Hazard, KY 41702
Phone (606) 435-7642

Other identifiers 1

IdentifierTypeStateIssuer
7100167330MedicaidKY

Other names 1

  • Primary Care Centers of Eastern Kentucky-Hazard Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031218000752 KY Part B Supplier - Clinic/Group Practice 3971415993 Receives reassigned benefits from 49 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hindman, KY; Scuddy, KY; Hyden, KY; Hazard, KY
O20210108001463 KY Part A Provider - Rural Health Clinic 3971415993 Practice locations: Hazard, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942275805. Details of each certification follow.

Rural health clinic certification: CCN 183918

Legal name
PRIMARY CARE CENTERS OF EASTERN KENTUCKY LLC
Doing business as
PRIMARY CARE CENTERS OF EASTERN KY- HAZARD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 12, 2003
Last certification
Jun 15, 2017
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Nov 29, 2007 in KY
Enrollment address
101 Town and Country LN Suite100
Hazard, KY 41701-9524

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 4

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
18D1011792Primary Care Centers of Eastern Kentucky - Hazard101 Town & Country Lane, Hazard, KY 41701ComplianceApr 7, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Pccek Holding Company Organization, Hazard, KY Holding company 5% Or Greater Direct Ownership Interest Dec 1, 2025 100%
Tonya Martin Individual 5% Or Greater Indirect Ownership Interest Mar 31, 2026 37%
Charla Napier Individual W-2 Managing EmployeeAd;Coo Mar 31, 2026
Barry Martin Individual 5% Or Greater Indirect Ownership InterestCeo/President Mar 31, 2026 14%
Corporate DirectorCeo/President Mar 31, 2026 100%
Pccek Employee Stock Ownership Trust Organization, Hazard, KY 5% Or Greater Indirect Ownership Interest Mar 31, 2026 49%

Facilities with the same owner 2

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

Change-of-ownership history 2

DateEventCounterparty
Jan 1, 2021 Change of OwnershipThis provider was the buyer Primary Care Centers of Eastern Kentucky - HazardCCN 183918, KY, NPI 1942275805
Jan 1, 2021 Change of OwnershipThis provider was the seller Primary Care Centers of Eastern Ky- HazardCCN 183918, KY, NPI 1942275805

Practitioners & affiliated clinicians

Practitioners 63

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 63

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1942275805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1988",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "41702",
            "telephone_number": "606-435-7642",
            "fax_number": "606-436-5282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 TOWN AND COUNTRY LN",
            "address_2": "SUITE100",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417019524",
            "telephone_number": "606-439-1300",
            "fax_number": "606-439-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE CENTERS OF EASTERN KENTUCKY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "BARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "606-439-1300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100167330",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Care Centers of Eastern Kentucky-Hazard",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hazard, KY

Sources for this page

Verify at the official NPI Registry.