Amg-Hillside LLC
Organization Active NPI Rural Health Clinic/Center · Pulaski, TN
NPI 1144052002 · NPPES record last updated Aug 19, 2024
Key facts
- NPI
- 1144052002
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- AMG-HILLSIDE LLC
- Practice address
- 104 Ivy LN
Pulaski, TN 38478-4550 - Phone
- (931) 292-6544
- Fax
- (931) 292-6547
- NPI assigned
- Aug 19, 2024
- Organization subpart
- No
Authorized official
- Name
- Charlotte Lawrence
- Title
- Secretary
- Phone
- (615) 920-7000
Other NPIs on the same Medicare enrollment 20
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 22
Facilities with the same owner 193
Practitioners 25
-
Andrea L Vanfleet, NP-C
-
Lisa Ann Weaver, FNP-C
-
Ginger Dawn Hamilton, FNP
-
Sara Beth Bush, MD
-
Holly Clem, NP-C
-
Leann D Gordon, CMM, NP
-
Christina Grover, FNP-C
-
Steve D. Hagan, NP
-
Shannon M Heard, N.P.
-
Amy Alicia Holt, APRN
-
Racheal M Howell, APRN-BC
-
Elizabeth Marie Louie, M.D.
-
Melissa Kay Pennington, FNP-C
-
Jennifer Marianne Rikard, NP-C
-
Christy Stapleton, FNP
-
John David Tullos, M.D.
-
Ross Parker Blair, APRN
-
McKay Jared Davis, DPM
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2216061 | Amg Hillside LLC | Provider-performed microscopy | Mar 8, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
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
- LLC · Proprietary
- Enrollment address
- 104 Ivy LN
Pulaski, TN 38478-4550
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Lifepoint Holdings 2 LLC |
5% Or Greater Indirect Ownership Interest | Aug 1, 2024 | 100% |
| Pamela Kane |
Corporate Officer |
Aug 1, 2024 | |
| DSB Acquisition LLC |
5% Or Greater Indirect Ownership Interest | Aug 1, 2024 | 100% |
| Laura C Hinson |
Corporate Officer |
Mar 12, 2025 | |
| Lifepoint Hospitals Holdings LLC |
5% Or Greater Indirect Ownership Interest | Aug 1, 2024 | 100% |
| Historic Lifepoint Hospitals, LLC |
5% Or Greater Indirect Ownership Interest | Aug 1, 2024 | 100% |
| Lifepoint Health Inc |
5% Or Greater Indirect Ownership Interest | Aug 1, 2024 | 100% |
| Charlotte E Lawrence |
Corporate Officer |
Aug 1, 2024 | |
| W-2 Managing Employee | Aug 1, 2024 | ||
| Lifepoint Medical Group-Hillside Inc |
5% Or Greater Direct Ownership Interest | Aug 1, 2024 | 100% |
| Elliott Brown |
Corporate Officer |
Apr 2, 2026 | |
| Klaus Michael Boel |
Corporate Officer |
Aug 19, 2024 | |
| W-2 Managing Employee |
Feb 1, 2025 | ||
| Christopher J Monte |
Corporate Officer |
Aug 1, 2024 | |
| Legacy Lifepoint Health LLC |
5% Or Greater Indirect Ownership Interest | Aug 1, 2024 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Amg-Hillside LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
- Southern Tennessee Primary Care Eastside
Other providers in Pulaski, TN
- Amg Hillside LLC
- Amg Hillside LLC
- Amg-Hillside LLC
- Amg-Hillside LLC
- Amg-Hillside LLC
- Amg-Hillside LLC
- Amg-Hillside LLC
- Amg-Hillside LLC
- Amg-Hillside LLC
- Amg-Hillside LLC
All providers in Pulaski, TN · Rural Health Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.