NPIMap

Organization Active NPI

Campbell County Hma LLC

Doing business as Tennova Primary Care Clinton

  • Rural Health Clinic/Center
  • Clinton, TN
National Provider Identifier
1093300717
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 Clinton
Practice address
2200 N Charles G Seivers Blvd
Clinton, TN 37716-6738
Phone
(423) 566-6872
Fax
(423) 566-6871
NPI assigned
Mar 4, 2021
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 NU Primary

Addresses

Primary practice location

2200 N Charles G Seivers Blvd
Clinton, TN 37716-6738

Mailing address

2200 N Charles G Seivers Blvd
Clinton, TN 37716-6738
Phone (423) 566-6872

Other names 1

  • Tennova Primary Care Clinton Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210313000013 TN Part A Provider - Rural Health Clinic 3173795168 Practice locations: Clinton, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093300717. Details of each certification follow.

Rural health clinic certification: CCN 443477

Legal name
CAMPBELL COUNTY HMA LLC
Doing business as
TENNOVA PRIMARY CARE CLINTON
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
2200 N Charles G Seivers Blvd
Clinton, TN 37716-6738
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).

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
44D2219876Campbell County Hma LLC2200 Charles G Seviers Blvd, Clinton, TN 37716Certificate of waiverJul 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Campbell County Hma LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

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 May 1, 2021
Kevin J Hammons Individual Corporate OfficerPresident / Board Member May 1, 2021
Corporate DirectorPresident/Board Member May 1, 2021
Nathaniel K Summar Individual Corporate DirectorVP Revenue Management May 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 May 1, 2021 100%
William Bradley Cash Individual Corporate OfficerExec VP May 1, 2021
Hma-Tri Holdings LLC Organization, Franklin, TN LLC 5% Or Greater Indirect Ownership Interest May 1, 2021 100%
Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest May 1, 2021 100%
Jason Kevin Johnson Individual Corporate OfficerSenior VP May 1, 2021
Roman Gabriel Ottinger Individual Corporate OfficerSr. VP/Treasurer May 1, 2021
Paula M Lalor Individual Corporate DirectorDirector May 1, 2021
Edna S Buffington-Price Individual Corporate DirectorVP/Authorized Official Mar 1, 2022
Christopher G Cobb Individual Corporate OfficerVP/Secretary May 1, 2021
CHS Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest May 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 Caryville

    • Rural Health Clinic/Center
    • Caryville, TN
    • NPI 1023613361

    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 2

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": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1093300717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 N CHARLES G SEIVERS BLVD",
            "city": "CLINTON",
            "state": "TN",
            "postal_code": "377166738",
            "telephone_number": "423-566-6872",
            "fax_number": "423-566-6871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 N CHARLES G SEIVERS BLVD",
            "city": "CLINTON",
            "state": "TN",
            "postal_code": "377166738",
            "telephone_number": "423-566-6872",
            "fax_number": "423-566-6871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMPBELL COUNTY HMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-04",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tennova Primary Care Clinton",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tennova Primary Care Clinton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, TN

Sources for this page

Verify at the official NPI Registry.