NPIMap

Organization Active NPI

Hickman Community Health Careservices

  • Rural Health Clinic/Center
  • Lyles, TN
National Provider Identifier
1225049570
Registry record updated Aug 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HICKMAN COMMUNITY HEALTH CARESERVICES
Practice address
5047 Highway 100
Lyles, TN 37098-1878
Phone
(931) 670-6525
Fax
(931) 670-6527
NPI assigned
Aug 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2011

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

Authorized official

Name
Mrs. Donna L Mathis
Title
Business Office Manager
Phone
(931) 729-6779

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

5047 Highway 100
Lyles, TN 37098-1878

Mailing address

5047 Highway 100
Lyles, TN 37098-1878
Phone (931) 670-6525

Other identifiers 2

IdentifierTypeStateIssuer
0443436MedicaidTN
4057061OtherTNBCBS

Other names 1

  • Hickman Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040115000449 TN Part B Supplier - Clinic/Group Practice 7315855368 Receives reassigned benefits from 83 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Centerville, TN

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners 73

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 73

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312848000000",
    "number": "1225049570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5047 HIGHWAY 100",
            "city": "LYLES",
            "state": "TN",
            "postal_code": "370981878",
            "telephone_number": "931-670-6525",
            "fax_number": "931-670-6527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5047 HIGHWAY 100",
            "city": "LYLES",
            "state": "TN",
            "postal_code": "370981878",
            "telephone_number": "931-670-6525",
            "fax_number": "931-670-6527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HICKMAN COMMUNITY HEALTH CARESERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2011-08-09",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "931-729-6779",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0443436",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4057061",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hickman Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lyles, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.