Active NPI
Covenant Family Practice, PC
- Family Medicine Physician
- Clarksville, TN
National Provider Identifier
1225073166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- COVENANT FAMILY PRACTICE, PC
- Practice address
- 1000 Highway 76
Clarksville, TN 37043-8405 - Phone
- (931) 245-8000
- Fax
- (931) 245-0605
- NPI assigned
- Jun 17, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Robert Alan Wilson, MD
- Title
- President
- Phone
- (931) 245-1150
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
1000 Highway 76
Clarksville, TN 37043-8405
Mailing address
PO Box 30459
Clarksville, TN 37040-0008
Phone (931) 245-8000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3718348 | Medicaid | TN | |
| 4062086 | Other | TN | TN BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040407000983 | TN | Part B Supplier - Clinic/Group Practice | 6305839093 |
Receives reassigned benefits from 26 practitioners Practice locations: Erin, TN; Dover, TN; Clarksville, TN |
National Provider Directory
National Provider DirectoryLocations
236 Uffelman Dr
Clarksville, TN 37043
Phone (931) 647-6305
251 Hillcrest Dr
Clarksville, TN 37043
Phone (931) 245-1150
21 Roby Dr
Erin, TN 37061
Phone (931) 289-2450
3443 Dickerson Pike
Ste 690
Nashville, TN 37207
Phone (615) 777-3223
Practitioners & affiliated clinicians
Practitioners 31
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Clarksville, TN
- NPI 1295882348
Family Medicine, TN
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1572912000000",
"number": "1225073166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 30459",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370400008",
"telephone_number": "931-245-8000",
"fax_number": "931-245-0605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 HIGHWAY 76",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370438405",
"telephone_number": "931-245-8000",
"fax_number": "931-245-0605"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COVENANT FAMILY PRACTICE, PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-17",
"last_updated": "2019-11-05",
"status": "A",
"authorized_official_last_name": "WILSON",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "ALAN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "931-245-1150",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3718348",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TN BCBS",
"identifier": "4062086",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; 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.