Cumberland Family Care PC
Organization Active NPI Family Medicine Physician · Sparta, TN
NPI 1225003809 · NPPES record last updated Jul 1, 2016
Key facts
- NPI
- 1225003809
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CUMBERLAND FAMILY CARE PC
- Practice address
- 457 Vista Dr
Sparta, TN 38583-1360 - Phone
- (931) 738-3383
- Fax
- (931) 738-8911
- NPI assigned
- Feb 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Mischelle Lynn Ferrell, MHA
- Title
- Practice Administrator
- Phone
- (931) 738-3383
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Practitioners 7
-
Haidee Star Ballew, FNP-C
-
Cameron Wayne Heady, PA-C
-
Marla J Moore, FNP
-
Ty T Webb, MD
-
April L Thornton, APN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0857831 | Cumberland Family Care PC | Provider-performed microscopy | Feb 29, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041110000115 | TN | Part B Supplier - Clinic/Group Practice | 8729041835 |
Receives reassigned benefits from 6 practitioners 1 other NPI on this enrollment Practice locations: Sparta, TN |
National Provider Directory
Locations
817 College St
Spencer, TN 38585
Phone (931) 946-2113
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/HJBFAD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
457 Vista Dr
Sparta, TN 38583-1360
Mailing address
457 Vista Dr
Sparta, TN 38583-1360
Phone (931) 738-3383
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3713471 | Medicaid | TN | |
| CI1932 | Other | TN | RAILROAD MEDICARE PIN |
Other providers in Sparta, TN
- Angela Cremeans
- Daniel Justin Cripps
- Olivia Hamby Crosland
- Colby Lee Cross
- Thomas Eugene Crosslin Jr.
- Cumberland Home Doctors, LLC
- Cumberland Physical Therapy and Rehabilitation
- Cumberland Plateau Surgical Associates
- Donna Gail Curran
- Joann L. Data
All providers in Sparta, 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.
- 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.