NPIMap

Organization Active NPI

Amg-Crockett LLC

Doing business as Summertown Medical Center

  • Rural Health Clinic/Center
  • Mt Pleasant, TN
National Provider Identifier
1255069639
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
AMG-CROCKETT LLC
Doing business as
Summertown Medical Center
Practice address
4995 Highway 43 N
Ste D
Mt Pleasant, TN 38474
Phone
(931) 964-0849
Fax
(931) 964-0852
NPI assigned
Aug 12, 2022
Last updated
Sep 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Authorized official

Name
Charlotte Lawrence
Title
Secretary
Phone
(615) 920-7000

Specialties & licenses 1

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

Addresses

Primary practice location

4995 Highway 43 N
Ste D
Mt Pleasant, TN 38474

Mailing address

330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000

Other names 1

  • Summertown Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071017000313 TN Part B Supplier - Clinic/Group Practice 4789770199 Receives reassigned benefits from 92 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lawrenceburg, TN; Winchester, TN; Pulaski, TN; Mt Pleasant, TN; Loretto, TN; Decherd, TN
O20221020000248 TN Part A Provider - Rural Health Clinic 4789770199 Practice locations: Mt Pleasant, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255069639. Details of each certification follow.

Rural health clinic certification: CCN 883929

Legal name
AMG-CROCKETT, LLC
Doing business as
SUMMERTOWN MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 13, 2022
Last certification
May 5, 2026
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Dec 15, 1998 in DE
Enrollment address
4955D Highway 43 N
Mt Pleasant, TN 38474-5010

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 20

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

View all 20

National Provider Directory

National Provider Directory
Tax ID family
Amg-Crockett LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lifepoint Holdings 2 LLC Organization, Brentwood, TN LLC 5% Or Greater Direct Ownership Interest Nov 16, 2018 100%
Pamela Kane Individual Corporate OfficerVice President Aug 9, 2022
DSB Acquisition LLC Organization, Brentwood, TN LLC 5% Or Greater Indirect Ownership Interest Nov 16, 2018 100%
Laura C Hinson Individual Corporate OfficerChief Financial Officer Mar 12, 2025
Lifepoint Hospitals Holdings LLC Organization, Brentwood, TN LLC 5% Or Greater Indirect Ownership Interest Nov 16, 2018 100%
Historic Lifepoint Hospitals, LLC Organization, Brentwood, TN LLC 5% Or Greater Indirect Ownership Interest Nov 16, 2018 100%
Lifepoint Health Inc Organization, Brentwood, TN Corporation 5% Or Greater Indirect Ownership Interest Nov 16, 2018 100%
Charlotte E Lawrence Individual Corporate OfficerSecretary Jan 21, 2022
Elliott Brown Individual Corporate OfficerSenior Vice President and Treasurer Apr 2, 2026
Klaus Michael Boel Individual Contracted Managing Employee Aug 19, 2024
Corporate OfficerPresident Aug 19, 2024
Christopher J Monte Individual Corporate OfficerVice President Nov 16, 2018
Legacy Lifepoint Health LLC Organization, Brentwood, TN LLC 5% Or Greater Indirect Ownership Interest Nov 16, 2018 100%

Facilities with the same owner 193

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Amg-Crockett, LLC

    dba First Choice Health Lawrenceburg

    • Rural Health Clinic/Center
    • Lawrenceburg, TN
    • NPI 1023840998

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Crockett, LLC

    dba Southern Tennessee Internal Medicine - Lawrenceburg

    • Rural Health Clinic/Center
    • Lawrenceburg, TN
    • NPI 1417739640

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Crockett, LLC

    dba First Choice Health Loretto

    • Rural Health Clinic/Center
    • Loretto, TN
    • NPI 1811543929

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Crockett, LLC

    dba Women's Health Clinic

    • Rural Health Clinic/Center
    • Lawrenceburg, TN
    • NPI 1891580858

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Family Health - Pulaski

    • Rural Health Clinic/Center
    • Pulaski, TN
    • NPI 1063294296

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Eastside

    • Rural Health Clinic/Center
    • Pulaski, TN
    • NPI 1144052002

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Lynnville

    • Rural Health Clinic/Center
    • Lynnville, TN
    • NPI 1407688369

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Ardmore

    • Rural Health Clinic/Center
    • Ardmore, TN
    • NPI 1558117028

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Hillside LLC

    dba First Choice Health - Pulaski

    • Rural Health Clinic/Center
    • Pulaski, TN
    • NPI 1568190551

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Cornersville

    • Rural Health Clinic/Center
    • Lewisburg, TN
    • NPI 1881426740

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Southern Tennessee LLC

    dba Highpoint Family Wellness - Winchester with Ascension Saint Thomas

    • Rural Health Clinic/Center
    • Winchester, TN
    • NPI 1063140051

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Southern Tennessee LLC

    dba Highpoint Family Wellness - Blackwell with Ascension Saint Thomas

    • Rural Health Clinic/Center
    • Tullahoma, TN
    • NPI 1174365803

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
View all 193

Practitioners & affiliated clinicians

Practitioners 10

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": "1660262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1255069639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275098",
            "telephone_number": "615-920-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4995 HIGHWAY 43 N",
            "address_2": "STE D",
            "city": "MT PLEASANT",
            "state": "TN",
            "postal_code": "38474",
            "telephone_number": "931-964-0849",
            "fax_number": "931-964-0852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG-CROCKETT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-12",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summertown Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Summertown Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mt Pleasant, TN

Sources for this page

Verify at the official NPI Registry.