Crockett Medical Clinic Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

CROCKETT MEDICAL CLINIC INC

Practice address

58 S. Bells St
Alamo, TN 38001

Phone

(731) 696-5401

Fax

(731) 696-5404

NPI assigned

Aug 14, 2006

Organization subpart

No

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

Authorized official

Name

Rita Croom

Title

Cfo

Phone

(731) 696-4670

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

Rural health clinic certification: CCN 448934

Legal name

CROCKETT MEDICAL CLINIC INC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jul 11, 2014

Last certification

Apr 8, 2022

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

May 17, 1993 in TN

Enrollment address

58 South Bells Street
Alamo, TN 38001-1700

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

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

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rebecca Baker, FNP

  • Family Nurse Practitioner
  • Alamo, TN
  • NPI 1730418385

  TN

  Medicare reassignment Care Compare group NPD
• Kristin Lea Byrd, APN

  • Family Nurse Practitioner
  • Alamo, TN
  • NPI 1548569700

  TN

  Medicare reassignment Care Compare group NPD
• Loren Carroll, MD

  • Family Medicine Physician
  • Jackson, TN
  • NPI 1104168178

  Family Medicine, TN

  Medicare reassignment Care Compare group NPD
• Donna Paige Clement, APN

  • Family Nurse Practitioner
  • Alamo, TN
  • NPI 1629272620

  TN

  Medicare reassignment Care Compare group NPD
• Lori Faye Laman, APN

  • Family Nurse Practitioner
  • Alamo, TN
  • NPI 1295906378

  TN

  Medicare reassignment Care Compare group NPD
• Raymond Wayne Rhear, MD

  • Family Medicine Physician
  • Alamo, TN
  • NPI 1659384253

  Family Medicine, TN

  Medicare reassignment Care Compare group NPD
• Karen B Webb, FNP

  • Nurse Practitioner
  • Alamo, TN
  • NPI 1902819501
  Medicare reassignment Care Compare group NPD
• Roderick Webb Jr.

  • Diagnostic Radiology Physician
  • Humboldt, TN
  • NPI 1154360741
  NPD (past)

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754006400000",
    "number": "1104839703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 S. BELLS ST",
            "city": "ALAMO",
            "state": "TN",
            "postal_code": "38001",
            "telephone_number": "731-696-5401",
            "fax_number": "731-696-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 S. BELLS ST",
            "city": "ALAMO",
            "state": "TN",
            "postal_code": "38001",
            "telephone_number": "731-696-5401",
            "fax_number": "731-696-5404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROCKETT MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2025-08-01",
        "certification_date": "2025-07-07",
        "status": "A",
        "authorized_official_last_name": "CROOM",
        "authorized_official_first_name": "RITA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "731-696-4670"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "3717707",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3717707",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Alamo Superintendent of Schools
• Donna Paige Clement, APN
• County of Crockett
• Crockett County Nursing Home, Inc.
• Crockett County Office on Aging, Inc.
• Crockett Spine & Sport PLLC
• Derrick Smith Counseling LLC
• Paula Eubanks
• Family Eye Care Group, LLC
• Firstcare Medical Center, PC

• All providers in Alamo, TN
• Rural Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.