Martin Children'S Clinic, LLC
Organization Active NPI Rural Health Clinic/Center · Martin, TN
NPI 1194049064 · NPPES record last updated May 9, 2017
Key facts
- NPI
- 1194049064
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 12549 (TN)
- Legal business name
- MARTIN CHILDREN'S CLINIC, LLC
- Practice address
- 130 Commons Dr
Martin, TN 38237-3879 - Phone
- (731) 587-5138
- Fax
- (731) 587-0552
- NPI assigned
- Mar 22, 2010
- Organization subpart
- No
Authorized official
- Name
- Mrs. Sharon Pierce Page, APN
- Title
- Owner
- Phone
- (731) 587-5138
Practitioners 5
-
Sharon P Page, CPNP
-
Celia Allman, FNP
-
Cassidy Belew, FNP
-
Melissa McMackin, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2004808 | Martin Children'S Clinic, LLC | Compliance | Oct 27, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Rural health clinic certification: CCN 448910
- Legal name
- MARTIN CHILDRENS CLINIC LLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 1, 2011
- Last certification
- Sep 11, 2024
- Ownership / control type
- 1A
- Organization structure
- LLC · Proprietary
- Enrollment address
- 130 Commons Dr
Martin, TN 38237-3879
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Roger Swaim |
5% Or Greater Direct Ownership Interest |
Jun 1, 2026 | 100% |
| Corporate Officer |
Jun 1, 2026 | ||
| Corporate Director |
Jun 1, 2026 | ||
| W-2 Managing Employee |
Jun 1, 2026 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100601000029 | TN | Part B Supplier - Clinic/Group Practice | 4587793526 |
Receives reassigned benefits from 1 practitioner Practice locations: Martin, TN |
| O20110120001208 | TN | Part a Provider - Rural Health Clinic | 4587793526 | Practice locations: Martin, TN |
National Provider Directory
Locations
215 Hawks Rd
Ste 3
Martin, TN 38237
Phone (731) 588-2881
130 Commons Dr
Martin, TN 38237
Phone (731) 587-5138
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 12549 | TN | Yes |
| Pediatric Nurse Practitioner |
363LP0200X | 12549 | TN |
Addresses
Primary practice location
130 Commons Dr
Martin, TN 38237-3879
Mailing address
130 Commons Dr
Martin, TN 38237-3879
Phone (731) 587-5138
Other providers in Martin, TN
- Jami L Maddox
- Katherine Anne Malik
- Lori Abbott Manley
- Audie B Marlar Jr.
- Martin Anesthesia Group Inc
- Martin Clinic Corp
- Martin Clinic Corp
- Martin Health
- Martin Health
- Martin Health
All providers in Martin, TN · Rural Health Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2017. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.