Organization Active NPI

Ripley Medical Clinic Inc

  • Family Medicine Physician
  • Ripley, TN
National Provider Identifier
1013012764
Registry record updated May 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RIPLEY MEDICAL CLINIC INC
Practice address
202 Tucker Ave
Ripley, TN 38063-1631
Phone
(731) 635-4741
Fax
(731) 660-8739
NPI assigned
Sep 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2026

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

Authorized official

Name
Heidi Bockholt
Title
Coo
Phone
(731) 413-8584

Specialties & licenses 2

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

Addresses

Primary practice location

202 Tucker Ave
Ripley, TN 38063-1631

Mailing address

202 Tucker Ave
Ripley, TN 38063-1631
Phone (731) 635-4741

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051219000067 TN Part B Supplier - Clinic/Group Practice 6800817842 Receives reassigned benefits from 5 practitioners
Practice locations: Ripley, TN

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
44D2144527Ripley Medical Clinic202 Tucker Street, Ripley, TN 38063ComplianceMar 5, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

202 Tucker Ave
Ste 604
Ripley, TN 38063

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17303/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779840000000",
    "number": "1013012764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 TUCKER AVE",
            "city": "RIPLEY",
            "state": "TN",
            "postal_code": "380631631",
            "telephone_number": "731-635-4741",
            "fax_number": "731-635-3466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 TUCKER AVE",
            "city": "RIPLEY",
            "state": "TN",
            "postal_code": "380631631",
            "telephone_number": "731-635-4741",
            "fax_number": "731-660-8739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIPLEY MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A",
        "authorized_official_last_name": "BOCKHOLT",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "731-413-8584"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ripley, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.