NPIMap

Organization Active NPI

Matthew Walker Comprehensive Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Clarksville, TN
National Provider Identifier
1104008747
Registry record updated Feb 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MATTHEW WALKER COMPREHENSIVE HEALTH CENTER, INC
Practice address
230 Dover Rd
Clarksville, TN 37042-4183
Phone
(931) 920-5000
Fax
(615) 320-6033
NPI assigned
Dec 5, 2007
Last updated
Feb 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2022

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

Authorized official

Name
Mrs. Katina Beard
Title
Chief Executive Officer
Phone
(615) 340-1265

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

230 Dover Rd
Clarksville, TN 37042-4183

Mailing address

1035 14TH Ave N
Nashville, TN 37208-3050
Phone (615) 327-9400

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040702000588 TN Part B Supplier - Clinic/Group Practice 4082691456 Receives reassigned benefits from 25 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clarksville, TN; Nashville, TN; Smyrna, TN
O20120824000047 TN Part A Provider - Federally Qualified Health Center (FQHC) 4082691456 Practice locations: Clarksville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104008747. Details of each certification follow.

Federally qualified health center certification: CCN 441951

Legal name
MATTHEW WALKER COMPREHENSIVE HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 24, 2012
Last certification
Aug 24, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 23, 1970 in TN
Enrollment address
230 Dover Road
Clarksville, TN 37042-4183

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Matthew Walker Comprehensive Health Center Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
James Halford Individual Corporate DirectorBoard Director May 22, 2012
Robin Calloway Individual W-2 Managing EmployeeHuman Resource Director May 22, 2012
Katina R Beard Individual W-2 Managing EmployeeChief Executive Officer May 22, 2012
Tera Hambrick Individual W-2 Managing EmployeeLegal Affairs Director Apr 1, 2012
Ida Williams Individual W-2 Managing EmployeeChief Medical Director Apr 1, 2012

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645747200000",
    "number": "1104008747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 14TH AVE N",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372083050",
            "telephone_number": "615-327-9400",
            "fax_number": "615-327-2806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 DOVER RD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370424183",
            "telephone_number": "931-920-5000",
            "fax_number": "615-320-6033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW WALKER COMPREHENSIVE HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A",
        "authorized_official_last_name": "BEARD",
        "authorized_official_first_name": "KATINA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "615-340-1265",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

Verify at the official NPI Registry.