NPIMap

Organization Active NPI

Primary Care of Jamestown, LLC

  • Rural Health Clinic/Center
  • Jamestown, TN
National Provider Identifier
1215717772
Registry record updated Feb 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PRIMARY CARE OF JAMESTOWN, LLC
Practice address
101 S Duncan St Ste C
Jamestown, TN 38556-3007
Phone
(931) 879-5864
Fax
(931) 879-3903
NPI assigned
Oct 3, 2023
Last updated
Feb 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2026

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

Authorized official

Name
Tamara Eroh
Title
Credentialing MGR
Phone
(931) 200-2246

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
General Practice Physician 208D00000X NU

Addresses

Primary practice location

101 S Duncan St Ste C
Jamestown, TN 38556-3007

Mailing address

PO Box 2801
Crossville, TN 38557-2801
Phone (931) 200-2246

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240224000265 TN Part A Provider - Rural Health Clinic 5496190969 Practice locations: Jamestown, TN
O20250916002513 TN Part B Supplier - Clinic/Group Practice 5496190969 Receives reassigned benefits from 6 practitioners
Practice locations: Jamestown, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215717772. Details of each certification follow.

Rural health clinic certification: CCN 888925

Legal name
PRIMARY CARE OF JAMESTOWN LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 3, 2025
Last certification
Feb 3, 2025
Ownership / control type
1A
Organization structure
LLCProprietary
Enrollment address
101 S Duncan St
Ste C
Jamestown, TN 38556-3007

National Provider Directory

National Provider Directory

Locations

101 S Duncan St
Ste C
Jamestown, TN 38556

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Johnny Wayne Presley Individual 5% Or Greater Indirect Ownership InterestPresident Feb 2, 2023 100%
Corporate OfficerPresident Feb 2, 2023 100%
W-2 Managing EmployeePresident Feb 2, 2023 100%
Presley Health LLC Organization, Crossville, TN LLC 5% Or Greater Direct Ownership Interest Jan 1, 2024 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1696291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770681600000",
    "number": "1215717772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2801",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385572801",
            "telephone_number": "931-200-2246",
            "fax_number": "931-707-9474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S DUNCAN ST STE C",
            "city": "JAMESTOWN",
            "state": "TN",
            "postal_code": "385563007",
            "telephone_number": "931-879-5864",
            "fax_number": "931-879-3903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE OF JAMESTOWN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-03",
        "last_updated": "2026-02-10",
        "certification_date": "2026-02-10",
        "status": "A",
        "authorized_official_last_name": "EROH",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "CREDENTIALING MGR",
        "authorized_official_telephone_number": "931-200-2246"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamestown, TN

Sources for this page

Verify at the official NPI Registry.