NPIMap

Organization Active NPI

Vanderbilt Integrated Providers, LLC

Doing business as Vanderbilt Integrated Internal Medicine

  • Rural Health Clinic/Center
  • Tullahoma, TN
National Provider Identifier
1164200747
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
VANDERBILT INTEGRATED PROVIDERS, LLC
Doing business as
Vanderbilt Integrated Internal Medicine
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
Last updated
Jun 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Authorized official

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

Specialties & licenses 1

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

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 names 1

  • Vanderbilt Integrated Internal Medicine Doing business as

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164200747. Details of each certification follow.

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
LLCNon-profit
Incorporated
Oct 12, 2023 in TN
Enrollment address
1805 N Jackson St
Ste 100
Tullahoma, TN 37388-2291

Other NPIs with the same Medicare PAC ID 5

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

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
44D0309810Vanderbilt Integrated Providers, LLC1805 N Jackson St, Suite 100, Tullahoma, TN 37388Certificate of waiverFeb 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
James S Kennedy MD6 organizations share this tax ID, including this one

Other organizations with this 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.

Member organizations 5

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

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 ControlSecartary Jan 1, 2021
Wendy Monaci Individual Corporate OfficerVice President May 1, 2021
W-2 Managing EmployeeVice 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 ControlPresident Jul 1, 2025

Owners & managing parties with NPI records 12

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

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-LafayetteLafayette, TN, CCN 883850 Rural health clinic 5% Or Greater Indirect Ownership Interest Jul 1, 1998
Vip Children's Clinic - SpringfieldSpringfield, TN, CCN 883849 Rural health clinic Limited Partnership Interest Jul 1, 1998
Vip Childrens Clinic-Pleasant ViewPleasant View, TN, CCN 883848 Rural health clinic Limited Partnership Interest Jul 1, 1998

Owned or controlled facilities with NPI records 3

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

  • Vip Midsouth, LLC

    dba VIP Children's Clinic - Pleasant View

    • Rural Health Clinic/Center
    • Pleasant View, TN
    • NPI 1336722669

    Limited Partnership Interest

    CMS ownership
  • Vip Midsouth, LLC

    dba VIP Children's Clinic - Springfield

    • Rural Health Clinic/Center
    • Springfield, TN
    • NPI 1528641859

    Limited Partnership Interest

    CMS ownership
  • Vip Midsouth, LLC

    dba VIP Children's Clinic - Lafayette

    • Rural Health Clinic/Center
    • Lafayette, TN
    • NPI 1588247811

    5% Or Greater Indirect Ownership Interest

    CMS ownership

Facilities with the same owner 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1694736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1164200747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 GREEN HILLS VILLAGE DR STE 200",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372152691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 N JACKSON ST STE 100",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882291",
            "telephone_number": "931-455-7767",
            "fax_number": "931-222-4057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANDERBILT INTEGRATED PROVIDERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-15",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "MONACI",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-936-3944"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vanderbilt Integrated Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vanderbilt Integrated Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tullahoma, TN

Sources for this page

Verify at the official NPI Registry.