NPIMap

Organization Active NPI

Covenant Family Practice, PC

  • Family Medicine Physician
  • Clarksville, TN
National Provider Identifier
1225073166
Registry record updated Nov 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
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
Last updated
Nov 5, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2019

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

Authorized official

Name
Dr. Robert Alan Wilson, MDNPI 1699782557
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)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 Directory

Locations

236 Uffelman Dr
Clarksville, TN 37043
Phone (931) 647-6305

251 Hillcrest Dr
Clarksville, TN 37043
Phone (931) 245-1150

304 Northcreek Blvd
Goodlettsville, TN 37072
Phone (615) 859-8488

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, and the practitioner matching its NPPES authorized official.

View all 31

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": [],
    "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.

Verify at the official NPI Registry.