NPIMap

Organization Active NPI

West Family Care Clinic PLLC

Doing business as West Family Care Clinic

  • Rural Health Clinic/Center
  • Newbern, TN
National Provider Identifier
1285008367
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WEST FAMILY CARE CLINIC PLLC
Doing business as
West Family Care Clinic
Practice address
100 E Highway 77
Newbern, TN 38059-1169
Phone
(731) 627-3553
Fax
(731) 882-1256
NPI assigned
Nov 30, 2015
Last updated
Jun 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Authorized official

Name
Laura Beth West, FNP-CNPI 1376932830
Title
Owner, Nurse Practitioner
Phone
(731) 627-3553

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
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

100 E Highway 77
Newbern, TN 38059-1169

Mailing address

100 E Highway 77
Newbern, TN 38059-1169
Phone (731) 627-3553

Other names 1

  • West Family Care Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161006001224 TN Part A Provider - Rural Health Clinic 8921396912 Practice locations: Newbern, TN
O20221207000475 TN Part B Supplier - Clinic/Group Practice 8921396912 Receives reassigned benefits from 4 practitioners
Practice locations: Newbern, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285008367. Details of each certification follow.

Rural health clinic certification: CCN 448974

Legal name
WEST FAMILY CARE CLINIC PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 16, 2017
Last certification
Feb 16, 2017
Ownership / control type
1A
Organization structure
LLCProprietary
Enrollment address
100 E Highway 77
Newbern, TN 38059-1169

National Provider Directory

National Provider Directory

Locations

100 E Highway 77
Newbern, TN 38059
Phone (731) 627-3553

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
Gregory West Individual W-2 Managing Employee Aug 1, 2022
Operational/Managerial Control Nov 6, 2016 80%
Laura B West Individual 5% Or Greater Direct Ownership Interest Aug 1, 2022 100%
Corporate OfficerCeo Aug 1, 2022 100%

Owners & managing parties with NPI records 1

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

  • Laura West
    • Primary Care Nurse Practitioner
    • Newbern, TN
    • NPI 1376932830

    5% Or Greater Direct Ownership Interest, Corporate Officer

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 6

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": "1448841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719273600000",
    "number": "1285008367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E HIGHWAY 77",
            "city": "NEWBERN",
            "state": "TN",
            "postal_code": "380591169",
            "telephone_number": "731-627-3553",
            "fax_number": "731-882-1256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E HIGHWAY 77",
            "city": "NEWBERN",
            "state": "TN",
            "postal_code": "380591169",
            "telephone_number": "731-627-3553",
            "fax_number": "731-882-1256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST FAMILY CARE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-30",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A",
        "authorized_official_last_name": "WEST",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "OWNER, NURSE PRACTITIONER",
        "authorized_official_telephone_number": "731-627-3553",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Family Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Family Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newbern, TN

Sources for this page

Verify at the official NPI Registry.