Family Medical Specialty Clinic PLLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

FAMILY MEDICAL SPECIALTY CLINIC PLLC

Practice address

12 Jackson Heights Drive
Family Medical & Specialty Clinic, LLC
Jackson, KY 41339

Phone

(606) 693-0199

Fax

(606) 666-9480

NPI assigned

Dec 4, 2006

Last updated

Sep 25, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. June E Abadilla, M.DNPI 1811975683

Title

President

Phone

(606) 693-0199

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992863021. Details of each certification follow.

• CCN B03881 Rural health clinic · Active · Details

Rural health clinic certification: CCN B03881

Legal name

FAMILY MEDICAL SPECIALTY CLINIC PLLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jan 27, 2022

Last certification

Jan 27, 2022

Ownership / control type

1A

Organization structure

LLCProprietary

Enrollment address

12 Jackson HTS
Jackson, KY 41339-6500

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

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

Owners & managing parties with NPI records 1

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

• June Elizabeth Abadilla

  • Internal Medicine Physician
  • Jackson, KY
  • NPI 1811975683

  5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

  CMS ownership

Practitioners 3

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.

• June Elizabeth Abadilla

  • Internal Medicine Physician
  • Jackson, KY
  • NPI 1811975683
  Medicare reassignment Care Compare group NPD Authorized official
• Melecio G Abordo Jr., M.D.

  • Internal Medicine Physician
  • Jackson, KY
  • NPI 1871590935
  Medicare reassignment Care Compare group NPD
• Brittany Michelle Wood, APRN

  • Primary Care Nurse Practitioner
  • Louisville, KY
  • NPI 1518752252
  Medicare reassignment NPD

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664064000000",
    "number": "1992863021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 JACKSON HEIGHTS DRIVE",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "41339",
            "telephone_number": "606-693-0199",
            "fax_number": "606-666-9480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 JACKSON HEIGHTS DRIVE",
            "address_2": "FAMILY MEDICAL & SPECIALTY CLINIC, LLC",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "41339",
            "telephone_number": "606-693-0199",
            "fax_number": "606-666-9480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL SPECIALTY CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2022-09-25",
        "certification_date": "2022-09-25",
        "status": "A",
        "authorized_official_last_name": "ABADILLA",
        "authorized_official_first_name": "JUNE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-693-0199",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31000904",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Elizabeth Eldridge, PA-C
• Beverly Dawn Ellis, APRN
• Tara Epperson, LCSW
• Eyemart Family Vision Care Inc (Eye Mart)
• Family Medical Specialty Clinic D.B.a. (Saint Mark's Family and Specialty Clinic)
• Flying Eye PLLC (Kentucky Eye Center)
• Rebecca Lynn Fryman
• Brittany Moore Fugate, D.O.
• Gaddis Chiropractic Center PLLC
• Randall Keith Gaddis, D.C.

• Rural Health Clinic/Center in Jackson, KY
• Providers in Jackson, KY by specialty
• Rural Health Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.