NPIMap

Organization Active NPI

Jackson Hospital Corporation

Doing business as Beattyville Family Medical Clinic

  • Nurse Practitioner
  • Beattyville, KY
National Provider Identifier
1992044747
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
JACKSON HOSPITAL CORPORATION
Doing business as
Beattyville Family Medical Clinic
Practice address
1027 Highway 11 N
Beattyville, KY 41311-9240
Phone
(606) 464-0061
Fax
(606) 464-0420
NPI assigned
Feb 13, 2013
Last updated
Jul 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
JACKSON HOSPITAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Authorized official

Name
Laura J Fey
Title
Sr. Director Physician Practice Rev
Phone
(615) 221-3641

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X KY
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X KY
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

1027 Highway 11 N
Beattyville, KY 41311-9240

Mailing address

1573 Mallory LN Ste 100
Brentwood, TN 37027-2895
Phone (152) 221-1400

Other names 1

  • BEATTYVILLE FAMILY MEDICAL CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040211000004 KY Part B Supplier - Clinic/Group Practice 0345134318 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
Practice locations: Campton, KY; Jackson, KY; Beattyville, KY

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 1

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

National Provider Directory

National Provider Directory
Tax ID family
Community Medical Clini4 organizations share this tax ID, including this one
Part of
Community Medical Clini

Other organizations with this tax ID 3

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

Locations

1027 Highway 11 N
Beattyville, KY 41311
Phone (606) 464-0061

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Beattyville Family Medical ClinicBeattyville, KY, CCN 183480 Rural health clinic 5% Or Greater Direct Ownership Interest Apr 29, 2016

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1360713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688688000000",
    "number": "1992044747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1573 MALLORY LN STE 100",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370272895",
            "telephone_number": "152-221-1400",
            "fax_number": "615-465-3007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 HIGHWAY 11 N",
            "city": "BEATTYVILLE",
            "state": "KY",
            "postal_code": "413119240",
            "telephone_number": "606-464-0061",
            "fax_number": "606-464-0420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HOSPITAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON HOSPITAL CORPORATION",
        "enumeration_date": "2013-02-13",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A",
        "authorized_official_last_name": "FEY",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SR. DIRECTOR PHYSICIAN PRACTICE REV",
        "authorized_official_telephone_number": "615-221-3641"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BEATTYVILLE FAMILY MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BEATTYVILLE FAMILY MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beattyville, KY

Sources for this page

Verify at the official NPI Registry.