NPIMap

Organization Active NPI

Coffee Medical Group LLC

Doing business as Unity Medical Center

  • Rural Acute Care Hospital
  • Manchester, TN
National Provider Identifier
1013969179
Registry record updated Apr 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
License
0000000017 Issued in TN
Legal business name
COFFEE MEDICAL GROUP LLC
Doing business as
Unity Medical Center
Practice address
481 Interstate Dr
Manchester, TN 37355-3108
Phone
(931) 728-3586
NPI assigned
May 17, 2006
Last updated
Apr 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2022

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

Authorized official

Name
Ms. Martha E McCormick
Title
Ceo
Phone
(931) 728-6354

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Acute Care Hospital 282NR1301X 0000000017 TN Primary

Addresses

Primary practice location

481 Interstate Dr
Manchester, TN 37355-3108

Mailing address

481 Interstate Dr
Manchester, TN 37355-3108
Phone (931) 728-6354

Other identifiers 4

IdentifierTypeStateIssuer
4039933OtherBCBS
0440007MedicaidTN
4039933OtherBCBST
4039933OtherBLUE CARE TENN CARE SEL

Other names 1

  • Unity Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118000203 TN Part B Supplier - Clinic/Group Practice 1850208794 Receives reassigned benefits from 50 practitioners
Practice locations: Manchester, TN; McMinnville, TN; Smyrna, TN; Tullahoma, TN; Winchester, TN
O20061113000520 TN Part A Provider - Hospital 1850208794 Practice locations: Manchester, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013969179. Details of each certification follow.

Hospital certification: CCN 440007

Legal name
COFFEE MEDICAL GROUP LLC
Doing business as
UNITY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 21, 2021
Beds
49
Ownership / control type
Private (not for profit)
Organization structure
LLCProprietary
Incorporated
Jun 1, 2002 in TN
Enrollment address
481 Interstate Dr
Manchester, TN 37355-3108
Other Hospital Practice Location
Hospital subgroups
General, Acute care, Swing-bed approved

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Unity Medical CenterCCN 440007 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Coffee Medical Group LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Member of 1

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1801 N Jackson St
Tullahoma, TN 37388
Phone (931) 393-3000

Networks

  • VA HMO

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Unity Medical Center Inc Organization, Manchester, TN Created for acquisition, Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 15, 2019 100%
Martha McCormick Individual Corporate OfficerCeo Jul 1, 2013 25%
W-2 Managing Employee Jun 1, 2011
Ashoke Mukherji Individual Corporate DirectorDirector of the Board Jul 1, 2015 50%
Doug McAbee Individual Corporate OfficerCfo Mar 1, 2024 25%
Medical Associates Development LLC Organization, Manchester, TN LLC 5% Or Greater Security Interest Jul 15, 2019 32%
Servisfirst Bank Organization, Nashville, TN Corporation, For-profit 5% Or Greater Security Interest Jul 15, 2019 56%

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 100

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 100

Affiliated clinicians 153

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 153

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649808000000",
    "number": "1013969179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "481 INTERSTATE DR",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373553108",
            "telephone_number": "931-728-6354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "481 INTERSTATE DR",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373553108",
            "telephone_number": "931-728-3586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "931-728-6354",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "TN",
            "license": "0000000017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4039933",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0440007",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "4039933",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE TENN CARE SEL",
            "identifier": "4039933",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Unity Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Unity Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manchester, TN

Sources for this page

Verify at the official NPI Registry.