NPIMap

Organization Active NPI

Amg-Hillside LLC

Doing business as Southern Tennessee Primary Care Eastside

  • Rural Health Clinic/Center
  • Pulaski, TN
National Provider Identifier
1144052002
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
AMG-HILLSIDE LLC
Doing business as
Southern Tennessee Primary Care Eastside
Practice address
104 Ivy LN
Pulaski, TN 38478-4550
Phone
(931) 292-6544
Fax
(931) 292-6547
NPI assigned
Aug 19, 2024
Last updated
Aug 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Authorized official

Name
Charlotte Lawrence
Title
Secretary
Phone
(615) 920-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

104 Ivy LN
Pulaski, TN 38478-4550

Mailing address

330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000

Other names 1

  • Southern Tennessee Primary Care Eastside Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070810000665 TN Part B Supplier - Clinic/Group Practice 9436240017 Receives reassigned benefits from 55 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pulaski, TN; Lynnville, TN; Lewisburg, TN; Lawrenceburg, TN; Ardmore, TN
O20241017001079 TN Part A Provider - Rural Health Clinic 9436240017 Practice locations: Pulaski, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144052002. Details of each certification follow.

Rural health clinic certification: CCN 888911

Legal name
AMG-HILLSIDE LLC
Doing business as
SOUTHERN TENNESSEE PRIMARY CARE EASTSIDE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 13, 2024
Last certification
Nov 13, 2024
Ownership / control type
1B
Organization structure
LLCProprietary
Enrollment address
104 Ivy LN
Pulaski, TN 38478-4550

Other NPIs with the same Medicare PAC ID 6

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

  • Amg-Hillside LLC

    dba Southern Tennessee Family Health - Pulaski

    • Rural Health Clinic/Center
    • Pulaski, TN
    • NPI 1063294296

    9436240017

    Same PAC ID
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Lynnville

    • Rural Health Clinic/Center
    • Lynnville, TN
    • NPI 1407688369

    9436240017

    Same PAC ID
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Ardmore

    • Rural Health Clinic/Center
    • Ardmore, TN
    • NPI 1558117028

    9436240017

    Same PAC ID
  • Amg-Hillside LLC

    dba First Choice Health - Pulaski

    • Rural Health Clinic/Center
    • Pulaski, TN
    • NPI 1568190551

    9436240017

    Same PAC ID
  • Amg-Hillside LLC

    dba Giles County Orthopaedic and Joint Center

    • Orthopaedic Surgery Physician
    • Pulaski, TN
    • NPI 1710105499

    9436240017

    Same PAC ID
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Cornersville

    • Rural Health Clinic/Center
    • Lewisburg, TN
    • NPI 1881426740

    9436240017

    Same PAC ID

Other NPIs on the same Medicare enrollment 20

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

View all 20

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
44D2216061Amg Hillside LLC104 Ivy Lane, Pulaski, TN 38478Provider-performed microscopyMar 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Amg-Hillside LLC23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Lifepoint Holdings 2 LLC Organization, Brentwood, TN LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2024 100%
Pamela Kane Individual Corporate OfficerVice President Aug 1, 2024
DSB Acquisition LLC Organization, New York, NY LLC, For-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2024 100%
Laura C Hinson Individual Corporate OfficerChief Financial Officer Mar 12, 2025
Lifepoint Hospitals Holdings LLC Organization, Brentwood, TN LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2024 100%
Historic Lifepoint Hospitals, LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2024 100%
Lifepoint Health Inc Organization, Brentwood, TN Corporation, For-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2024 100%
Charlotte E Lawrence Individual Corporate OfficerSecretary Aug 1, 2024
W-2 Managing Employee Aug 1, 2024
Lifepoint Medical Group-Hillside Inc Organization, Brentwood, TN Corporation, For-profit 5% Or Greater Direct Ownership Interest Aug 1, 2024 100%
Elliott Brown Individual Corporate OfficerSenior Vice President and Treasurer Apr 2, 2026
Klaus Michael Boel Individual Corporate OfficerPresident Aug 19, 2024
W-2 Managing EmployeePresident Feb 1, 2025
Christopher J Monte Individual Corporate OfficerVice President Aug 1, 2024
Legacy Lifepoint Health LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2024 100%

Facilities with the same owner 193

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

  • Amg-Crockett LLC

    dba Summertown Medical Center

    • Rural Health Clinic/Center
    • Mt Pleasant, TN
    • NPI 1255069639

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Crockett, LLC

    dba First Choice Health Lawrenceburg

    • Rural Health Clinic/Center
    • Lawrenceburg, TN
    • NPI 1023840998

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Crockett, LLC

    dba Southern Tennessee Internal Medicine - Lawrenceburg

    • Rural Health Clinic/Center
    • Lawrenceburg, TN
    • NPI 1417739640

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Crockett, LLC

    dba First Choice Health Loretto

    • Rural Health Clinic/Center
    • Loretto, TN
    • NPI 1811543929

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Crockett, LLC

    dba Women's Health Clinic

    • Rural Health Clinic/Center
    • Lawrenceburg, TN
    • NPI 1891580858

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Family Health - Pulaski

    • Rural Health Clinic/Center
    • Pulaski, TN
    • NPI 1063294296

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint Medical Group-Hillside Inc

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Lynnville

    • Rural Health Clinic/Center
    • Lynnville, TN
    • NPI 1407688369

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint Medical Group-Hillside Inc

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Ardmore

    • Rural Health Clinic/Center
    • Ardmore, TN
    • NPI 1558117028

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint Medical Group-Hillside Inc

    CMS ownership
  • Amg-Hillside LLC

    dba First Choice Health - Pulaski

    • Rural Health Clinic/Center
    • Pulaski, TN
    • NPI 1568190551

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint Medical Group-Hillside Inc

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Cornersville

    • Rural Health Clinic/Center
    • Lewisburg, TN
    • NPI 1881426740

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Lifepoint Medical Group-Hillside Inc

    CMS ownership
  • Amg-Southern Tennessee LLC

    dba Highpoint Family Wellness - Winchester with Ascension Saint Thomas

    • Rural Health Clinic/Center
    • Winchester, TN
    • NPI 1063140051

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Southern Tennessee LLC

    dba Highpoint Family Wellness - Blackwell with Ascension Saint Thomas

    • Rural Health Clinic/Center
    • Tullahoma, TN
    • NPI 1174365803

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
View all 193

Practitioners & affiliated clinicians

Practitioners 4

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": "1724025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1144052002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275098",
            "telephone_number": "615-920-7000",
            "fax_number": "615-920-8775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 IVY LN",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384784550",
            "telephone_number": "931-292-6544",
            "fax_number": "931-292-6547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG-HILLSIDE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Tennessee Primary Care Eastside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pulaski, TN

Sources for this page

Verify at the official NPI Registry.