NPIMap

Organization Active NPI

Jackson-Madison County General Hospital

Doing business as Hospice of West Tennessee

  • Community Based Hospice Care Agency
  • Jackson, TN
National Provider Identifier
1104816966
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
0000000335 Issued in TN
Legal business name
JACKSON-MADISON COUNTY GENERAL HOSPITAL
Doing business as
Hospice of West Tennessee
Practice address
1804 Highway 45 Byp
Jackson, TN 38305-4436
Phone
(731) 664-4220
Fax
(731) 664-4231
NPI assigned
Oct 24, 2005
Last updated
Oct 14, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
JACKSON-MADISON COUNTY GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

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

Authorized official

Name
Ms. Tina Prescott
Title
President and Ceo
Phone
(731) 541-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 0000000335 TN Primary

Addresses

Primary practice location

1804 Highway 45 Byp
Jackson, TN 38305-4436

Mailing address

1804 Highway 45 Byp
Jackson, TN 38305-4436
Phone (731) 664-4220

Other names 1

  • Hospice of West Tennessee Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040102000741 TN Part A Provider - Hospice 3678481975 Practice locations: Jackson, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104816966. Details of each certification follow.

Hospice certification: CCN 441514

Legal name
JACKSON MADISON COUNTY GENERAL HOSPITAL
Doing business as
HOSPICE OF WEST TENNESSEE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 24, 1988
Last certification
Jun 3, 2021
Ownership / control type
Other
Organization structure
GovernmentNon-profit
Incorporated
Oct 24, 1998 in TN
Enrollment address
1804 Highway 45 Bypass
Suite 100
Jackson, TN 38305-4436

Other NPIs with the same Medicare PAC ID 7

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of West TennesseeCCN 441514 · All quality measures
Ownership
Non-Profit
Certified
Oct 24, 1988
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Medical Center Lab11 organizations share this tax ID, including this one
Part of
Medical Center Lab

Other organizations with this tax ID 10

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

Locations

1804 Highway 45 Byp
Jackson, TN 38305
Phone (731) 664-4220

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Jeffrey D Blankenship Individual W-2 Managing EmployeeChief Financial Officer Apr 30, 2016
Jackson Madison County General Hospital Organization, Jackson, TN Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 1986 100%
Tina Prescott Individual Corporate OfficerPresident and Ceo Sep 12, 2024
W-2 Managing EmployeePresident and Ceo Sep 12, 2024

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 13

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
West Tennessee Healthcare Milan HospitalMilan, TN, CCN 440060 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 27, 1998
West Tennessee Healthcare Milan HospitalMilan, TN, CCN 44U060 Hospital 5% Or Greater Direct Ownership Interest (5%) Aug 24, 1998
Jackson Madison County General HospitalJackson, TN, CCN 440002 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 31, 2007
West Tennessee Healthcare Rehabilitation Hospital Jackson, a PartnershJackson, TN, CCN 443036 Hospital 5% Or Greater Direct Ownership Interest (50%) Oct 8, 2015
West Tennessee Healthcare Rehabilitation Hospital Cane Creek, a PartneMartin, TN, CCN 443030 Hospital 5% Or Greater Direct Ownership Interest (50%) Jul 1, 2017
West Tennessee Healthcare Rehabilitation Hospital Cane Creek, a PartneMartin, TN, CCN 44Y030 Hospital 5% Or Greater Direct Ownership Interest (50%) Jul 1, 2017
West Tennessee Healthcare Volunteer HospitalMartin, TN, CCN 440061 Hospital Operational/Managerial Control Jan 2, 2019
West Tennessee Healthcare Dyersburg HospitalDyersburg, TN, CCN 440072 Hospital 5% Or Greater Direct Ownership Interest (50%)
Operational/Managerial Control (50%)		 Jun 1, 2018
Jun 1, 2018
Select Specialty Hospital - West TennesseeJackson, TN, CCN 442018 Hospital 5% Or Greater Direct Ownership Interest (15%) Mar 1, 2023
Extendicare Home Health of Western TennesseeUnion City, TN, CCN 447434 Home health agency 5% Or Greater Indirect Ownership Interest (33%) Oct 1, 2008
Extendicare Home Health of West TennesseeDyersburg, TN, CCN 447284 Home health agency 5% Or Greater Indirect Ownership Interest (33%) Sep 1, 2007
Medical Center Home Health, LLCJackson, TN, CCN 447101 Home health agency 5% Or Greater Indirect Ownership Interest (33%) Oct 1, 2008
West Tennessee Medical Group Primary Care CaruthersvilleCaruthersville, MO, CCN 793800 Rural health clinic Operational/Managerial Control Jun 1, 2018

Owned or controlled facilities with NPI records 12

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 12

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

Practitioners & affiliated clinicians

Practitioners 3

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.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728864000000",
    "number": "1104816966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 HIGHWAY 45 BYP",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054436",
            "telephone_number": "731-664-4220",
            "fax_number": "731-664-4231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 HIGHWAY 45 BYP",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054436",
            "telephone_number": "731-664-4220",
            "fax_number": "731-664-4231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON-MADISON COUNTY GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON-MADISON COUNTY GENERAL HOSPITAL",
        "enumeration_date": "2005-10-24",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A",
        "authorized_official_last_name": "PRESCOTT",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "731-541-5000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "TN",
            "license": "0000000335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospice of West Tennessee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.