NPIMap

Individual provider Active NPI

Mark A Vann, FNP-BC

  • Family Nurse Practitioner
  • Decherd, TN
National Provider Identifier
1194036327
Registry record updated Feb 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
15060 Issued in TN
Practice address
2008 Decherd Blvd
Decherd, TN 37324-3818
Phone
(931) 962-9000
Fax
(931) 967-1791
NPI assigned
Jun 22, 2010
Last updated
Feb 26, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 15060 TN Primary

Addresses

Primary practice location

2008 Decherd Blvd
Decherd, TN 37324-3818

Mailing address

2008 Decherd Blvd.
Decherd, TN 37324
Phone (931) 962-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101103000886 TN Practitioner - Nurse Practitioner 4880798297 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Woodland Wellness IncGroup PAC ID 3678824927, 3 clinicians

Practice addresses (Care Compare)

115 N Woodland St
Manchester, TN 37355-1573
Phone (931) 954-5219

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Coffee Medical Group LLC CurrentSince Mar 26, 2024 Accepting new patients
Coffee Medical Group LLC CurrentSince Mar 26, 2024 Accepting new patients
Henson's Family Medical LLC Family Current Accepting new patients
Woodland Wellness, Inc CurrentSince May 26, 2018 Accepting new patients
Woodland Wellness, Inc CurrentSince Mar 23, 2018 Accepting new patients
Accurate Medical Practice Solutions PastSince Oct 16, 2006 Accepting new patients
Coffee Medical Group LLC Past Accepting new patients

Locations

115 N Woodland St
Manchester, TN 37355
Phone (931) 723-7904

481 Interstate Dr
Manchester, TN 37355
Phone (931) 728-3586

482 Interstate Dr
Manchester, TN 37355
Phone (931) 728-4718

501 N Jackson St
Tullahoma, TN 37388
Phone (931) 222-4213

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Woodland Wellness IncManchester, TN, CCN 883830 Rural health clinic 5% Or Greater Direct Ownership Interest
Corporate Officer
W-2 Managing Employee
Operational/Managerial Control		 Mar 23, 2018
Mar 23, 2018
Mar 23, 2018
Mar 23, 2018
Woodland Wellness of TullahomaTullahoma, TN, CCN 888920 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
Corporate Officer (50%)
W-2 Managing Employee (50%)		 Mar 23, 2018
Mar 23, 2018
Mar 23, 2018

Owned or controlled facilities with NPI records 2

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

  • Woodland Wellness, Inc
    • Rural Health Clinic/Center
    • Manchester, TN
    • NPI 1548766025

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

    CMS ownership
  • Woodland Wellness, Inc

    dba Woodland Wellness 0f Tullahoma

    • Rural Health Clinic/Center
    • Tullahoma, TN
    • NPI 1699545780

    5% Or Greater Direct Ownership Interest, Corporate Officer, W-2 Managing Employee

    CMS ownership

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361836800000",
    "number": "1194036327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 DECHERD BLVD.",
            "city": "DECHERD",
            "state": "TN",
            "postal_code": "37324",
            "telephone_number": "931-962-9000",
            "fax_number": "931-967-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 DECHERD BLVD",
            "city": "DECHERD",
            "state": "TN",
            "postal_code": "373243818",
            "telephone_number": "931-962-9000",
            "fax_number": "931-967-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANN",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-22",
        "last_updated": "2013-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "15060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decherd, TN

Sources for this page

Verify at the official NPI Registry.