NPIMap

Juniper Health, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Campton, KY

NPI 1962823393 · NPPES record last updated Jan 15, 2020

Key facts

NPI
1962823393
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
License
700132A (KY)
Legal business name
JUNIPER HEALTH, INC
Practice address
202 Plummer Street
Campton, KY 41301-7879
Phone
(606) 668-7385
Fax
(606) 668-7009
NPI assigned
Jan 3, 2014
Organization subpart
Yes
Parent organization (as reported)
JUNIPER HEALTH, INC.

Authorized official

Name
Mrs. Karen S Ditsch
Title
Ceo
Phone
(606) 464-0151

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Owners & managing parties with NPI records 1

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

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 16

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

Corporate family (same tax ID) 14

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

Practitioners 23

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2072005Jhi Wolfe County Family Medical Clinic
202 Plummer, Campton, KY 41301		Certificate of waiverJan 22, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in KY

Federally qualified health center certification: CCN 181919

Legal name
JUNIPER HEALTH INC
Doing business as
JHI WOLFE COUNTY FAMILY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 17, 2014
Last certification
Jul 17, 2014
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Dec 3, 2003 in KY
Enrollment address
202 Plummer St
Campton, KY 41301-9381

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
Jamie L Moore
Individual 		Corporate Director
Board Member		 Aug 1, 2021
Lisa Stamper
Individual 		Corporate Officer
Board Secretary		 Aug 1, 2021
Corporate Director
Board Member		 Jan 1, 2011
Burley Hudson
Individual 		Corporate Officer
Board Chair		 Jan 1, 2005
Lowell Hamilton
Individual 		Corporate Director
Board Member		 Jul 1, 2021
Cathy Hayes
Individual 		Corporate Director
Board Member		 Jan 1, 2009
Samuel T Faulkner
Individual 		Corporate Director
Board Member		 Apr 1, 2024
Diane Dunahoo
Individual 		Corporate Officer
Board Member		 Jan 1, 2004
Sharon R Calhoun
Individual 		Corporate Director
Board Member		 Mar 31, 2024
Derrick J Hamilton
Individual 		Corporate Officer
Ceo		 Aug 1, 2019
W-2 Managing Employee
Ceo		 Aug 1, 2019
Richard Ackley
Individual 		Corporate Officer
Cao		 Aug 1, 2019
W-2 Managing Employee
Cao		 Aug 1, 2019
Darren Back
Individual 		Corporate Director
Board Member		 Aug 1, 2021

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050214000128 KY Part B Supplier - Clinic/Group Practice 2961453618 Receives reassigned benefits from 25 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Liberty, KY; Sandy Hook, KY; Rogers, KY; Jackson, KY; Campton, KY; Frenchburg, KY; Hazel Green, KY; Beattyville, KY…
O20140721002538 KY Part a Provider - Federally Qualified Health Center (FQHC) 2961453618 Practice locations: Campton, KY

National Provider Directory

Tax ID family
Juniper Health Inc (15 organizations share this tax ID)
Part of
Juniper Health Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 700132A KY Yes

Addresses

Primary practice location

202 Plummer Street
Campton, KY 41301-7879

Mailing address

PO Box 690
Beattyville, KY 41311-0690
Phone (606) 464-0151

Other identifiers

IdentifierTypeStateIssuer
181919OtherKYMEDICARE FQHC PTAN
31000862MedicaidKY
9521OtherKYMEDICARE PART B

Other names

  • JHI Wolfe County Family Medical Clinic Doing business as

Other providers in Campton, KY

All providers in Campton, KY · Federally Qualified Health Center (FQHC) in Kentucky

Sources for this page

Verify at the official NPI Registry.