Ocoee Regional Health Corporation
Organization Active NPI Federally Qualified Health Center (FQHC) · Pikeville, TN
NPI 1265645204 · NPPES record last updated Jun 29, 2021
Key facts
- NPI
- 1265645204
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- OCOEE REGIONAL HEALTH CORPORATION
- Practice address
- 3625 US 127
Pikeville, TN 37367 - Phone
- (423) 447-6287
- Fax
- (423) 447-6315
- NPI assigned
- May 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Bill R Moats
- Title
- Ceo
- Phone
- (423) 338-8995
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 13
Practitioners 6
-
Julie Mae Brewer, M.D.
-
Pamela P Jones-Singleton, FNP-BC
-
Patricia Anne Mitchum, M.D.
-
Kayla Tanyee Perry, MSN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0904146 | Bledsoe County Primary Care Center | Compliance | Apr 3, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Federally qualified health center certification: CCN 441866
- Legal name
- OCOEE REGIONAL HEALTH CORPORATION
- Doing business as
- BLEDSOE COUNTY PRIMARY CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 25, 1994
- Last certification
- Jul 25, 1994
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 22, 1978 in TN
- Enrollment address
- 3625 Main St
Pikeville, TN 37367-5319
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Kimberly Bishop |
Corporate Director | Aug 12, 2010 | |
| William Moats |
Corporate Director | Aug 12, 2010 | |
| W-2 Managing Employee | Aug 12, 2010 | ||
| Skylar Creasman |
Corporate Director |
Sep 1, 2021 | |
| Charles Ross |
Corporate Director |
May 1, 2022 | |
| Patti Dalton |
Corporate Director | Aug 12, 2010 | |
| Pearson Devaul |
Corporate Officer |
Jan 1, 2018 | |
| W-2 Managing Employee |
Jan 1, 2018 | ||
| Linda Davis |
Corporate Director | Aug 12, 2010 | |
| Bill Hollin |
Corporate Director | Aug 12, 2010 | |
| Chandler Blakely |
Corporate Officer |
Mar 1, 2021 | |
| W-2 Managing Employee |
Mar 1, 2023 | ||
| Rita Hammons |
Corporate Director | Aug 12, 2010 | |
| John Myers |
Corporate Director |
May 1, 2014 | |
| Nelson Cope |
Corporate Director |
Jan 1, 2019 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Benton Family Health Care Center |
Federally qualified health center | Operational/Managerial Control | Jul 1, 1978 |
| Grundy County Primary Care Center |
Federally qualified health center | Operational/Managerial Control | Jan 1, 1990 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110304000187 | TN | Part a Provider - Federally Qualified Health Center (FQHC) | 1355233693 | Practice locations: Pikeville, TN |
National Provider Directory
- Tax ID family
- Rhea County PR Imary Care
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
3625 US 127
Pikeville, TN 37367
Mailing address
PO Box 976
Pikeville, TN 37367-0976
Phone (423) 447-6287
Other names
- Bledsoe County Primary Care Center
Other providers in Pikeville, TN
- Medicine Women LLC
- Michael Smith Construction
- Cheryl Miller
- Christopher Martin Noble
- Northland Hearing Centers, Inc.
- Sarah Grace Standefer Olendorf
- Alexandra Pendergrass
- Kayla Tanyee Perry
- Pikeville Clinic, LLC
- Pikeville Family Dentistry
All providers in Pikeville, TN · Federally Qualified Health Center (FQHC) in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.