Erlanger Health
Organization Active NPI Rural Health Clinic/Center · Pikeville, TN
NPI 1003518929 · NPPES record last updated Mar 22, 2023
Key facts
- NPI
- 1003518929
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ERLANGER HEALTH
- Practice address
- 136 Wheelertown Ave
Pikeville, TN 37367-5247 - Phone
- (423) 447-7784
- Fax
- (423) 778-4833
- NPI assigned
- Mar 22, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- ERLANGER HEALTH
Authorized official
- Name
- Lynn Dejaco
- Title
- Cfo, Evp
- Phone
- (423) 778-4712
Owned or controlled facilities with NPI records 7
Other NPIs with the same Medicare PAC ID 10
Corporate family (same tax ID) 11
Related certifications (CCN) 1
Change of ownership 1
Practitioners 504
-
John Aaron, MD
-
Allan Akin, MD
-
Joshua Peter Alpers, M.D.
-
Diana M. Alvarez, M.D.
-
Jennifer Suzanne Alvarez, M.D.
-
Sachin H. Amin, M.D.
-
Alicia C Andrews, D.O.
-
Kailey Ellis Ankar, FNP-C
-
Tia Marie Aryal, M.D.
-
James Gilbert Atherton, M.D.
-
Kellie Dianne Azor, AGNP-C
-
Haley Lynne Baker, PT, DPT
-
Ryan Thomas Barnes, M.D.
-
Tamara L. Bennett, PA-C
-
Cullen Black, MD
-
Michele April Boaz, P.T.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Rural health clinic certification: CCN 443442
- Legal name
- ERLANGER HEALTH
- Doing business as
- ERLANGER BLEDSOE INTERNAL MEDICINE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 10, 2011
- Last certification
- Mar 13, 2017
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 16, 2022 in TN
- Enrollment address
- 136 Wheelertown Ave
Pikeville, TN 37367-5247 - Related CCNs
- 441306
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Vicky B Gregg |
Corporate Director |
Jul 1, 2023 | |
| Sheila Chapnerkar Boyington |
Corporate Director |
Jul 1, 2023 | |
| Jim Coleman |
Corporate Officer |
Jul 1, 2023 | |
| Lynn S Dejaco |
Corporate Officer |
Jul 1, 2023 | |
| Jeff Woodard |
Corporate Officer |
Jul 1, 2023 | |
| Mike Shaver |
W-2 Managing Employee |
Jul 1, 2023 |
All facility ownership & control disclosures 8
| Facility | Type | Role | Since |
|---|---|---|---|
| Erlanger Murphy Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2023 |
| Erlanger Murphy Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2023 |
| Erlanger Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2023 |
| Erlanger Bledsoe Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2023 |
| Erlanger Murphy Medical Group, Family |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2023 |
| Erlanger MMC Urgent Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2023 |
| Erlanger Primary Care Peachtree |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2023 |
| Erlanger Andrews Family Practice |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2023 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jul 1, 2023 | Change of Ownership |
Erlanger Bledsoe-Internal Medicine & Pediatrics |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230802003206 | TN | Part a Provider - Rural Health Clinic | 1153780226 | Practice locations: Pikeville, TN |
National Provider Directory
- Tax ID family
- Erlanger Health
- Part of
- Erlanger Health
Networks
- AL HMO D-SNP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
136 Wheelertown Ave
Pikeville, TN 37367-5247
Mailing address
136 Wheelertown Ave
Pikeville, TN 37367-5247
Phone (423) 447-7784
Other names
- BLEDSOE HOSPITAL RHC
Other providers in Pikeville, TN
- Anna Davenport
- Anne Davis
- Fredrick S Dibrell
- Rebecca L Edington
- Emergency Physicians, Inc.
- Erlanger Health
- Erlanger Health
- Eye Centers of Tennessee, LLC
- April McMillen Guinn
- Bradley S Hargis
All providers in Pikeville, TN · Rural Health Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.