NPIMap

Organization Active NPI

Thomas W. Conway

Doing business as Primary Care Center

  • Family Medicine Physician
  • Newport, TN
National Provider Identifier
1033180807
Registry record updated May 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
16692 Issued in TN
Legal business name
THOMAS W. CONWAY
Doing business as
Primary Care Center
Practice address
434 4TH St
Suite 310
Newport, TN 37821-3746
Phone
(423) 623-0640
Fax
(423) 623-7615
NPI assigned
Jan 30, 2006
Last updated
May 18, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2010

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

Authorized official

Name
Mrs. Melanie McCollum
Title
Practice Manager
Phone
(423) 623-0640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 16692 TN Primary

Addresses

Primary practice location

434 4TH St
Suite 310
Newport, TN 37821-3746

Mailing address

434 4TH St
Suite 310
Newport, TN 37821-3746
Phone (423) 623-0640

Other identifiers 2

IdentifierTypeStateIssuer
3718054MedicaidTN
3718054OtherMEDICARE GROUP ID

Other names 1

  • Primary Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040819001172 TN Part B Supplier - Clinic/Group Practice 5496729105 Receives reassigned benefits from 4 practitioners
Practice locations: Newport, 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
44D0701686Primary Care Center of Newport, the434 Fourth Street, Suite 310, Newport, TN 37821ComplianceFeb 2, 2027

National Provider Directory

National Provider Directory

Locations

434 4th St
Ste 310
Newport, TN 37821
Phone (423) 623-0640

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274140800000",
    "number": "1033180807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 4TH ST",
            "address_2": "SUITE 310",
            "city": "NEWPORT",
            "state": "TN",
            "postal_code": "378213746",
            "telephone_number": "423-623-0640",
            "fax_number": "423-623-7615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 4TH ST",
            "address_2": "SUITE 310",
            "city": "NEWPORT",
            "state": "TN",
            "postal_code": "378213746",
            "telephone_number": "423-623-0640",
            "fax_number": "423-623-7615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS W. CONWAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2010-05-18",
        "status": "A",
        "authorized_official_last_name": "MCCOLLUM",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "423-623-0640",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "16692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3718054",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID",
            "identifier": "3718054",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2010; 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.