Cumberland Family Care P.C.
Organization Active NPI Family Medicine Physician · Spencer, TN
NPI 1184754111 · NPPES record last updated Jul 1, 2016
Key facts
- NPI
- 1184754111
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CUMBERLAND FAMILY CARE P.C.
- Practice address
- 817 College St
Spencer, TN 38585-3436 - Phone
- (931) 946-2113
- Fax
- (931) 946-2248
- NPI assigned
- Mar 7, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- CUMBERLAND FAMILY CARE, P.C.
Authorized official
- Name
- Mischelle L Ferrell, MHA
- Title
- Practice Administrator
- Phone
- (931) 738-3383
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 1
-
Ty T Webb, MD
Other NPIs with the same Medicare PAC ID 1
Practitioners 5
-
Haidee Star Ballew, FNP-C
-
Cameron Wayne Heady, PA-C
-
Marla J Moore, FNP
-
Ty T Webb, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Rural health clinic certification: CCN 443957
- Legal name
- CUMBERLAND FAMILY CARE P.C.
- Doing business as
- CUMBERLAND FAMILY CARE VAN BUREN CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 14, 2006
- Last certification
- May 1, 2018
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Incorporated
- May 27, 1998 in TN
- Enrollment address
- 817 College St
Spencer, TN 38585-3436
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Mischelle Ferrell |
W-2 Managing Employee | Dec 15, 2004 | |
| Ty T Webb |
5% Or Greater Direct Ownership Interest | Dec 15, 2004 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060523000104 | TN | Part a Provider - Rural Health Clinic | 8729041835 | Practice locations: Spencer, TN |
National Provider Directory
- Part of
- Cumberland Family Care
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
817 College St
Spencer, TN 38585-3436
Mailing address
457 Vista Dr
Sparta, TN 38583-1360
Phone (931) 738-3383
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 44-3957 | Other | TN | RURAL HEALTH CLINIC DESIGNATION |
Other names
- Cumberland Family Care Van Buren Clinic
Other providers in Spencer, TN
- Haidee Star Ballew
- Candace Heather Brewer
- Mindy Copeland
- County of Van Buren Supt T of Schools
- Crescent Wound Care Inc
- Cumberland Family Care, P.C.
- Abigail Ewing Dixon
- Audra Nichole Dixon
- Grant Ernest Fraser
- Generations Health Association, Inc.
All providers in Spencer, TN · Family Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.