NPIMap

Organization Active NPI

SDG Primary and Immediate Care LLC

  • Rural Health Clinic/Center
  • Halls, TN
National Provider Identifier
1225437585
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SDG PRIMARY AND IMMEDIATE CARE LLC
Practice address
201 S Front St
Halls, TN 38040-1547
Phone
(731) 836-5617
NPI assigned
Aug 21, 2014
Last updated
Jan 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Authorized official

Name
Jeffrey S Hampton, FNPNPI 1275702672
Title
President
Phone
(731) 676-1840

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse Practitioner 363LF0000X

Addresses

Primary practice location

201 S Front St
Halls, TN 38040-1547

Mailing address

201 S Front St
Halls, TN 38040-1547
Phone (731) 836-5617

Other identifiers 1

IdentifierTypeStateIssuer
Q007486MedicaidTN

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150303000316 TN Part B Supplier - Clinic/Group Practice 2264758689 Receives reassigned benefits from 7 practitioners
Practice locations: Dyersburg, TN; Halls, TN; Milan, TN; Ripley, TN
O20150715001523 TN Part A Provider - Rural Health Clinic 2264758689 Practice locations: Halls, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225437585. Details of each certification follow.

Rural health clinic certification: CCN 448953

Legal name
SDG PRIMARY AND IMMEDIATE CARE LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 5, 2015
Last certification
Mar 26, 2024
Ownership / control type
1C
Organization structure
LLCProprietary
Enrollment address
201 S Front St
Halls, TN 38040-1547

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2089360SDG Primary and Immediate Care201 S Front St, Halls, TN 38040Certificate of waiverMar 4, 2027

National Provider Directory

National Provider Directory

Locations

12410 Telecom Dr
Milan, TN 38358
Phone (734) 686-8600

108 East Dr
Newbern, TN 38059
Phone (731) 285-6600

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
Stephanie M Sells Individual 5% Or Greater Direct Ownership Interest Jan 1, 2015 50%
Jeffrey S Hampton Individual 5% Or Greater Direct Ownership Interest Aug 5, 2014 50%
W-2 Managing Employee Aug 5, 2014 50%

Owners & managing parties with NPI records 2

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

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": "1408579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1225437585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S FRONT ST",
            "city": "HALLS",
            "state": "TN",
            "postal_code": "380401547",
            "telephone_number": "731-836-5617",
            "fax_number": "731-836-5284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S FRONT ST",
            "city": "HALLS",
            "state": "TN",
            "postal_code": "380401547",
            "telephone_number": "731-836-5617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SDG PRIMARY AND IMMEDIATE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-21",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "HAMPTON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "731-676-1840",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q007486",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Halls, TN

Sources for this page

Verify at the official NPI Registry.