NPIMap

Organization Active NPI

Restoration Clinic

  • Primary Care Nurse Practitioner
  • Decatur, TN
National Provider Identifier
1174226757
Registry record updated Feb 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
RESTORATION CLINIC
Practice address
16850 State Highway 58 South
Suite a
Decatur, TN 37322
Phone
(423) 506-3781
Fax
(423) 454-0125
NPI assigned
Mar 23, 2023
Last updated
Feb 6, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
RESTORATION CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 6, 2024

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

Authorized official

Name
English Paige Roberts, FNPNPI 1326384991
Title
Owner
Phone
(423) 334-2300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Primary Care Nurse Practitioner 363LP2300X Primary

Addresses

Primary practice location

16850 State Highway 58 South
Suite a
Decatur, TN 37322

Mailing address

16850 State Highway 58 S Ste a
Decatur, TN 37322-5259
Phone (423) 507-7961

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140729000468 TN Part B Supplier - Clinic/Group Practice 1456577451 Receives reassigned benefits from 13 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Decatur, TN
O20231227002371 TN Part A Provider - Rural Health Clinic 1456577451 Practice locations: Decatur, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174226757. Details of each certification follow.

Rural health clinic certification: CCN 883970

Legal name
RESTORATION CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 2, 2024
Last certification
Jul 2, 2024
Ownership / control type
1A
Organization structure
LLCProprietary
Enrollment address
16850 State Highway 58 S
Ste a
Decatur, TN 37322-5259

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

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
44D2295374Restoration Clinic16850 State Hwy 58 South, Suite a, Decatur, TN 37322Certificate of waiverDec 10, 2027

National Provider Directory

National Provider Directory
Tax ID family
Restoration Clinic2 organizations share this tax ID, including this one
Part of
Restoration Clinic

Other organizations with this tax ID 1

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

Locations

116 N Main St
Ste C
Decatur, TN 37322
Phone (423) 506-2945

16850 State Highway 58 S
Decatur, TN 37322
Phone (423) 334-2300

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
English Paige Roberts Individual 5% Or Greater Direct Ownership Interest May 13, 2014 100%
Corporate OfficerPres May 13, 2014 100%
W-2 Managing EmployeePres May 13, 2014 100%
Operational/Managerial ControlPres May 13, 2014 100%

Owners & managing parties with NPI records 1

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

  • English Paige Roberts, FNP-C
    • Primary Care Nurse Practitioner
    • Decatur, TN
    • NPI 1326384991

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1679529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1174226757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16850 STATE HIGHWAY 58 S STE A",
            "city": "DECATUR",
            "state": "TN",
            "postal_code": "373225259",
            "telephone_number": "423-507-7961",
            "fax_number": "423-454-0125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16850 STATE HIGHWAY 58 SOUTH",
            "address_2": "SUITE A",
            "city": "DECATUR",
            "state": "TN",
            "postal_code": "37322",
            "telephone_number": "423-506-3781",
            "fax_number": "423-454-0125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATION CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RESTORATION CLINIC",
        "enumeration_date": "2023-03-23",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "ENGLISH",
        "authorized_official_middle_name": "PAIGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-334-2300",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, TN

Sources for this page

Verify at the official NPI Registry.