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Vanderbilt Integrated Providers, LLC

Organization Active NPI Rural Health Clinic/Center · Tullahoma, TN

NPI 1164200747 · NPPES record last updated Jun 12, 2024

Key facts

NPI
1164200747
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
VANDERBILT INTEGRATED PROVIDERS, LLC
Practice address
1805 N Jackson St Ste 100
Tullahoma, TN 37388-2291
Phone
(931) 455-7767
Fax
(931) 222-4057
NPI assigned
Sep 15, 2023
Organization subpart
No

Authorized official

Name
Wendy D Monaci
Title
Vice President
Phone
(615) 936-3944

Owners & managing parties with NPI records 12

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

Owned or controlled facilities with NPI records 3

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

Other NPIs with the same Medicare PAC ID 5

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

Corporate family (same tax ID) 5

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.

Facilities with the same owner 19

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

Practitioners 82

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

View all 82

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0309810Vanderbilt Integrated Providers, LLC
1805 N Jackson St, Suite 100, Tullahoma, TN 37388		Certificate of waiverFeb 28, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TN

Rural health clinic certification: CCN 883958

Legal name
VANDERBILT INTEGRATED PROVIDERS LLC
Doing business as
VANDERBILT INTEGRATED INTERNAL MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 14, 2024
Last certification
Mar 14, 2024
Ownership / control type
2B
Organization structure
LLC · Non-profit
Incorporated
Oct 12, 2023 in TN
Enrollment address
1805 N Jackson St
Ste 100
Tullahoma, TN 37388-2291

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Karen Nanney
Individual 		Operational/Managerial Control
Secartary		 Jan 1, 2021
Wendy Monaci
Individual 		Corporate Officer
Vice President		 May 1, 2021
W-2 Managing Employee
Vice President		 May 1, 2021
Vanderbilt University Medical Center
Organization · Nashville, TN
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Sep 1, 2020 100%
Operational/Managerial Control Dec 1, 2023
Rick W Wright
Individual 		Operational/Managerial Control
President		 Jul 1, 2025

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Vip Children'S Clinic-Lafayette
Lafayette, TN · CCN 883850		 Rural health clinic 5% Or Greater Indirect Ownership Interest Jul 1, 1998
Vip Children'S Clinic - Springfield
Springfield, TN · CCN 883849		 Rural health clinic Limited Partnership Interest Jul 1, 1998
Vip Childrens Clinic-Pleasant View
Pleasant View, TN · CCN 883848		 Rural health clinic Limited Partnership Interest Jul 1, 1998

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20231020002834 TN Part a Provider - Rural Health Clinic 7012817919 Practice locations: Tullahoma, TN

National Provider Directory

Tax ID family
Rebecca Morgan (6 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

1805 N Jackson St Ste 100
Tullahoma, TN 37388-2291

Mailing address

3841 Green Hills Village Dr Ste 200
Nashville, TN 37215-2691

Other identifiers

IdentifierTypeStateIssuer
Q092315MedicaidTN

Other names

  • Vanderbilt Integrated Internal Medicine Doing business as

Other providers in Tullahoma, TN

All providers in Tullahoma, TN · Rural Health Clinic/Center in Tennessee

Sources for this page

Verify at the official NPI Registry.