NPIMap

Organization Active NPI

Upper Cumberland Rural Health Clinic PLLC

Doing business as Baxter Medical Clinic RHC

  • Rural Health Clinic/Center
  • Baxter, TN
National Provider Identifier
1285311829
Registry record updated Jul 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC
Doing business as
Baxter Medical Clinic RHC
Practice address
319 Broad St
Baxter, TN 38544-5117
Phone
(931) 858-2116
NPI assigned
Jul 4, 2023
Last updated
Jul 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2023

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

Authorized official

Name
Pushpendra K Jain, MDNPI 1689748634
Title
Ceo
Phone
(931) 528-8899

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 NU Primary

Addresses

Primary practice location

319 Broad St
Baxter, TN 38544-5117

Mailing address

319 Broad St
Baxter, TN 38544-5117

Other names 1

  • Baxter Medical Clinic RHC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231227001033 TN Part A Provider - Rural Health Clinic 8820198138 Practice locations: Baxter, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285311829. Details of each certification follow.

Rural health clinic certification: CCN 888902

Legal name
UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC
Doing business as
BAXTER MEDICAL CLINIC RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 25, 2024
Last certification
Jun 25, 2024
Ownership / control type
1A
Organization structure
LLCProprietary
Enrollment address
319 Broad St
Baxter, TN 38544-5117

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Baxter Medical Clinic RHC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

319 Broad St
Baxter, TN 38544
Phone (931) 537-3601

4 Courthouse Sq
Byrdstown, TN 38549
Phone (931) 864-0222

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Pushpendra K Jain Individual 5% Or Greater Direct Ownership Interest Jul 1, 2023 100%
Corporate OfficerPresident Jul 1, 2023 100%
W-2 Managing EmployeePresident Jul 1, 2023 100%
Operational/Managerial ControlPresident Jul 1, 2023 100%

Owners & managing parties with NPI records 1

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

  • Pushpendra K Jain, MD
    • Family Medicine Physician
    • Cookeville, TN
    • NPI 1689748634

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 3

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": "1688428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688428800000",
    "number": "1285311829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 BROAD ST",
            "city": "BAXTER",
            "state": "TN",
            "postal_code": "385445117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 BROAD ST",
            "city": "BAXTER",
            "state": "TN",
            "postal_code": "385445117",
            "telephone_number": "931-858-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-04",
        "last_updated": "2023-07-04",
        "certification_date": "2023-07-04",
        "status": "A",
        "authorized_official_last_name": "JAIN",
        "authorized_official_first_name": "PUSHPENDRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "931-528-8899",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baxter Medical Clinic RHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baxter, TN

Sources for this page

Verify at the official NPI Registry.