NPIMap

Organization Active NPI

Faith Family Wellness Clinic, PLLC

  • Rural Health Clinic/Center
  • Shelbyville, TN
National Provider Identifier
1184107302
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAITH FAMILY WELLNESS CLINIC, PLLC
Practice address
2012 N Main St
Shelbyville, TN 37160-2022
Phone
(931) 492-5290
Fax
(931) 492-5292
NPI assigned
Sep 13, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2022

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

Authorized official

Name
Kristin McBayNPI 1093148959
Title
Owner
Phone
(931) 492-5290

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
Rural Health Clinic/Center 261QR1300X Primary
Primary Care Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

2012 N Main St
Shelbyville, TN 37160-2022

Mailing address

2012 N Main St
Shelbyville, TN 37160-2022
Phone (931) 492-5290

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190215001260 TN Part B Supplier - Clinic/Group Practice 8426396540 Receives reassigned benefits from 2 practitioners
Practice locations: Shelbyville, TN
O20211117002158 TN Part A Provider - Rural Health Clinic 8426396540 Practice locations: Shelbyville, TN

Rural health clinic certification: CCN 883909

Legal name
FAITH FAMILY WELLNESS CLINIC PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 28, 2022
Last certification
May 4, 2026
Ownership / control type
1C
Organization structure
LLCProprietary
Enrollment address
2012 N Main St
Shelbyville, TN 37160-2022

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
44D2155651Faith Family Wellness Clinic2012 North Main Street, Shelbyville, TN 37160Certificate of waiverOct 1, 2026

National Provider Directory

National Provider Directory

Locations

2012 N Main St
Shelbyville, TN 37160
Phone (931) 492-5290

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18553/brand/1/csg/1/fhir/r4

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
Kristin E McBay Individual 5% Or Greater Direct Ownership Interest Oct 1, 2018 100%
Corporate Officer Oct 1, 2018 100%
Operational/Managerial Control Oct 1, 2018 100%

Owners & managing parties with NPI records 1

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

  • Kristin McBay, NP-C
    • Family Nurse Practitioner
    • Shelbyville, TN
    • NPI 1093148959

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658793600000",
    "number": "1184107302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2012 N MAIN ST",
            "city": "SHELBYVILLE",
            "state": "TN",
            "postal_code": "371602022",
            "telephone_number": "931-492-5290",
            "fax_number": "931-492-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2012 N MAIN ST",
            "city": "SHELBYVILLE",
            "state": "TN",
            "postal_code": "371602022",
            "telephone_number": "931-492-5290",
            "fax_number": "931-492-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAITH FAMILY WELLNESS CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-13",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A",
        "authorized_official_last_name": "MCBAY",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-492-5290"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelbyville, TN

Sources for this page

Verify at the official NPI Registry.