NPIMap

Organization Active NPI

Shamrock Community Hospital Inc

Doing business as Shamrock Community Hospital Medical Group

  • Family Medicine Physician
  • Erin, TN
National Provider Identifier
1033878277
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SHAMROCK COMMUNITY HOSPITAL INC
Doing business as
Shamrock Community Hospital Medical Group
Practice address
5001 E Main St
Erin, TN 37061-4115
Phone
(931) 289-4211
NPI assigned
Dec 15, 2021
Last updated
Aug 1, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SHAMROCK COMMUNITY HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Authorized official

Name
Larry Henson
Title
RCD
Phone
(336) 944-6420

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU
Family Medicine Physician 207Q00000X NU Primary
Diagnostic Radiology Physician 2085R0202X NU
Surgery Physician 208600000X NU
Hospitalist Physician 208M00000X NU

Addresses

Primary practice location

5001 E Main St
Erin, TN 37061-4115

Mailing address

5001 E Main St
Erin, TN 37061-4115
Phone (931) 289-4211

Other identifiers 1

IdentifierTypeStateIssuer
Q079943MedicaidTN

Other names 1

  • Shamrock Community Hospital Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220829003239 TN Part B Supplier - Clinic/Group Practice 8325422082 Receives reassigned benefits from 56 practitioners
Practice locations: Erin, TN

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Part of
Shamrock Community Hospital

Practitioners & affiliated clinicians

Practitioners 62

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 62

NPI Registry JSON

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

{
    "created_epoch": "1639526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722470400000",
    "number": "1033878277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5001 E MAIN ST",
            "city": "ERIN",
            "state": "TN",
            "postal_code": "370614115",
            "telephone_number": "931-289-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5001 E MAIN ST",
            "city": "ERIN",
            "state": "TN",
            "postal_code": "370614115",
            "telephone_number": "931-289-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAMROCK COMMUNITY HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHAMROCK COMMUNITY HOSPITAL INC",
        "enumeration_date": "2021-12-15",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "HENSON",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "RCD",
        "authorized_official_telephone_number": "336-944-6420"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q079943",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shamrock Community Hospital Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Erin, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.