NPIMap

Organization Active NPI

Campbell County Hma LLC

Doing business as Tennova Primary Care Caryville

  • Rural Health Clinic/Center
  • Caryville, TN
National Provider Identifier
1023613361
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CAMPBELL COUNTY HMA LLC
Doing business as
Tennova Primary Care Caryville
Practice address
140 John McGhee Blvd
Caryville, TN 37714-3155
Phone
(865) 647-3230
Fax
(423) 566-6871
NPI assigned
Dec 3, 2020
Last updated
Mar 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Authorized official

Name
Paula Lalor
Title
Director /Delegated Official
Phone
(629) 215-3953

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

140 John McGhee Blvd
Caryville, TN 37714-3155

Mailing address

140 John McGhee Blvd
Caryville, TN 37714-3155
Phone (865) 647-3230

Other names 1

  • Tennova Primary Care Caryville Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111019000020 TN Part B Supplier - Clinic/Group Practice 3173795168 Receives reassigned benefits from 12 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Caryville, TN; Clinton, TN; La Follette, TN; Lafollette, TN
O20210205000345 TN Part A Provider - Rural Health Clinic 3173795168 Practice locations: Caryville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023613361. Details of each certification follow.

Rural health clinic certification: CCN 443478

Legal name
CAMPBELL COUNTY HMA LLC
Doing business as
TENNOVA PRIMARY CARE CARYVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 10, 2020
Last certification
Nov 10, 2020
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Jun 10, 2011 in TN
Enrollment address
140 John McGhee Blvd
Caryville, TN 37714-3155
Related CCNs
440033

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 4

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

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
44D2217530Campbell County Hma LLC140 John McGhee Blvd, Caryville, TN 37714Certificate of waiverJul 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Campbell County Hma LLC13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

2221 Jacksboro Pike
Ste C19C
La Follette, TN 37766
Phone (423) 907-1720

905 E Central Ave
Ste B
La Follette, TN 37766
Phone (423) 907-1542

7557 Dannaher Way
Ste G104
Powell, TN 37849
Phone (865) 859-7490

Networks

  • devoted network organization-5b6e8479-727f-40cf-ba4e-9b59e43aa45e

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Ronald Cain Individual W-2 Managing EmployeeCeo Apr 1, 2021
Kevin J Hammons Individual Corporate OfficerPresident / Board MBR Apr 1, 2021
Corporate DirectorPresident/Board Member Apr 21, 2021
Nathaniel K Summar Individual Corporate DirectorVP Revenue Management Apr 1, 2021
Justin D Pitt Individual Corporate OfficerExec VP/Assist Sec/Board Member Mar 1, 2022
Corporate DirectorExec VP/Assist Sec/Board Member Mar 1, 2022
Health Management Associates LLC Organization, Franklin, TN LLC 5% Or Greater Direct Ownership Interest Apr 1, 2021 100%
William Bradley Cash Individual Corporate OfficerExec VP Apr 1, 2021
Hma-Tri Holdings LLC Organization, Franklin, TN LLC 5% Or Greater Indirect Ownership Interest Apr 1, 2021 100%
Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Apr 1, 2021 100%
Jason Kevin Johnson Individual Corporate OfficerSenior VP Apr 1, 2021
Roman Gabriel Ottinger Individual Corporate OfficerSenior VP / Treasurer Apr 1, 2021
Paula M Lalor Individual Corporate DirectorDirector Apr 1, 2021
Edna S Buffington-Price Individual Corporate DirectorVP/Authorized Official Mar 1, 2022
Christopher G Cobb Individual Corporate OfficerVP/Secretary Apr 1, 2021
CHS Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Apr 1, 2021 100%

Facilities with the same owner 120

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

  • Campbell County Hma LLC
    • Skilled Nursing Facility
    • La Follette, TN
    • NPI 1023099447

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Campbell County Hma LLC

    dba Tennova Primary Care Clinton

    • Rural Health Clinic/Center
    • Clinton, TN
    • NPI 1093300717

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Campbell County Hma LLC

    dba Tennova LaFollette Medical Center Clinic

    • Rural Health Clinic/Center
    • La Follette, TN
    • NPI 1407838261

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Campbell County Hma LLC
    • Rural Health Clinic/Center
    • La Follette, TN
    • NPI 1639183353

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Campbell County Hma, LLC

    dba Tennova Healthcare-LaFollette Medical Center

    • Psychiatric Hospital Unit
    • La Follette, TN
    • NPI 1548241953

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Campbell County Hma, LLC

    dba Tennova Healthcare-LaFollette Medical Center

    • General Acute Care Hospital
    • La Follette, TN
    • NPI 1639151301

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Campbell County Hma, LLC

    dba Tennova Healthcare-LaFollette Medical Center

    • Medicare Defined Swing Bed Hospital Unit
    • La Follette, TN
    • NPI 1831171693

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Cocke County Hma, LLC

    dba Tennova Healthcare-Newport Medical Center

    • General Acute Care Hospital
    • Newport, TN
    • NPI 1972576247

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Jefferson County Hma LLC

    dba Tennova Healthcare-Jefferson Memorial Hospital

    • General Acute Care Hospital
    • Jefferson City, TN
    • NPI 1972585347

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Metro Knoxville Hma LLC

    dba Tennova Healthcare North Knoxville Medical Center

    • General Acute Care Hospital
    • Powell, TN
    • NPI 1043292899

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Affinity Hospital LLC

    dba Grandview Medical Center

    • General Acute Care Hospital
    • Birmingham, AL
    • NPI 1023061405

    CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC

    CMS ownership
  • Affinity Hospital LLC

    dba Grandview Medical Center

    • Psychiatric Hospital Unit
    • Birmingham, AL
    • NPI 1043263221

    CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC

    CMS ownership
View all 120

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1023613361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 JOHN MCGHEE BLVD",
            "city": "CARYVILLE",
            "state": "TN",
            "postal_code": "377143155",
            "telephone_number": "865-647-3230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 JOHN MCGHEE BLVD",
            "city": "CARYVILLE",
            "state": "TN",
            "postal_code": "377143155",
            "telephone_number": "865-647-3230",
            "fax_number": "423-566-6871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMPBELL COUNTY HMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-03",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "LALOR",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "DIRECTOR /DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "629-215-3953"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tennova Primary Care Caryville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Caryville, TN

Sources for this page

Verify at the official NPI Registry.