NPIMap

Organization Active NPI

Humphreys County Community Health Services Inc

Doing business as Ascension Saint Thomas Three Rivers Primary Care

  • Rural Health Clinic/Center
  • Waverly, TN
National Provider Identifier
1164033213
Registry record updated Apr 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HUMPHREYS COUNTY COMMUNITY HEALTH SERVICES INC
Doing business as
Ascension Saint Thomas Three Rivers Primary Care
Practice address
451 Highway 13 S
Waverly, TN 37185-2109
Phone
(931) 296-0211
Fax
(931) 296-0199
NPI assigned
Aug 12, 2020
Last updated
Apr 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2022

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

Authorized official

Name
Shannon Allison
Title
Finance Manager
Phone
(931) 296-0111

Specialties & licenses 1

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

Addresses

Primary practice location

451 Highway 13 S
Waverly, TN 37185-2109

Mailing address

451 Highway 13 S
Waverly, TN 37185-2109
Phone (931) 296-0211

Other names 1

  • Ascension Saint Thomas Three Rivers Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200910000577 TN Part A Provider - Rural Health Clinic 9931276359 Practice locations: Waverly, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164033213. Details of each certification follow.

Rural health clinic certification: CCN 443471

Legal name
HUMPHREYS COUNTY COMMUNITY HEALTH SERVICES, INC.
Doing business as
ASCENSION SAINT THOMAS THREE RIVERS PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 15, 2020
Last certification
Mar 4, 2026
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 29, 2008 in TN
Enrollment address
451 Highway 13 S
Waverly, TN 37185-2109
Related CCNs
441303

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Humphreys County Community Health Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member of 1

Organizations this organization is a member of, according to 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
Sienna Miller Individual W-2 Managing EmployeeEnrollment Supervisor Feb 26, 2025
Brandon Williams Individual Corporate DirectorCfo Oct 31, 2022
Shannon Allison Individual Corporate OfficerCfo Aug 3, 2015
W-2 Managing EmployeeCfo Aug 3, 2015
Freda Russell Individual Corporate OfficerCeo May 9, 2011 10%
Corporate DirectorCeo May 9, 2011 10%
W-2 Managing EmployeeCeo May 9, 2011 10%
Operational/Managerial ControlCeo May 9, 2011 10%
Humphreys County Community Health Services, Inc. Organization, Waverly, TN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2008 100%

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Ascension Saint Thomas Three RiversWaverly, TN, CCN 441303 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2008
Ascension Saint Thomas Three RiversWaverly, TN, CCN 44Z303 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2008

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

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": "1597190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649030400000",
    "number": "1164033213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 HIGHWAY 13 S",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371852109",
            "telephone_number": "931-296-0211",
            "fax_number": "931-296-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 HIGHWAY 13 S",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371852109",
            "telephone_number": "931-296-0211",
            "fax_number": "931-296-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMPHREYS COUNTY COMMUNITY HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-12",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A",
        "authorized_official_last_name": "ALLISON",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "FINANCE MANAGER",
        "authorized_official_telephone_number": "931-296-0111"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Saint Thomas Three Rivers Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waverly, TN

Sources for this page

Verify at the official NPI Registry.