Jefferson County Nursing Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

138 Issued in TN

Legal business name

JEFFERSON COUNTY NURSING HOME

Practice address

914 Industrial Park Rd
Dandridge, TN 37725-4700

Phone

(865) 397-3163

Fax

(865) 397-4225

NPI assigned

Oct 28, 2005

Last updated

Aug 29, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Roger L Mynatt

Title

Administrator

Phone

(865) 397-3163

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285624361. Details of each certification follow.

• CCN 445473 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 445473

Legal name

JEFFERSON COUNTY NURSING HOME

Doing business as

JEFFERSON COUNTY NURSING HOME

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 22, 2004

Last certification

Aug 17, 2022

Beds

160

Ownership / control type

County

Organization structure

GovernmentNon-profit

Enrollment address

914 Industrial Park Rd
Dandridge, TN 37725-4700

Nursing home name

JEFFERSON COUNTY NURSING HOME

Other NPIs with the same Medicare PAC ID 1

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

• Jefferson County Nursing Home

  • Skilled Nursing Facility
  • White Pine, TN
  • NPI 1982324182

  3072414135

  Same PAC ID

Listed as

Jefferson County Nursing HomeCCN 445473 · All quality measures

Overall star rating

3 of 5

Health inspections

4 of 5

Staffing

4 of 5

Quality measures

1 of 5

Type

Medicare and Medicaid

Ownership

Government - County

Certified

Jan 22, 2004

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

160141.3 residents per day on average

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

Tax ID family

Jefferson Co Nursing Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Jefferson County Nursing Home

  • Skilled Nursing Facility
  • White Pine, TN
  • NPI 1982324182
  NPD tax ID

All disclosed owners & managing parties 4

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

Owners & managing parties with NPI records 1

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

• Rual Swanson, MD

  • Family Medicine Physician
  • Dandridge, TN
  • NPI 1174529432

  Adp of the SNF

  CMS ownership

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Jefferson County Nursing Home

  • Skilled Nursing Facility
  • White Pine, TN
  • NPI 1982324182

  Other

  CMS ownership

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Jefferson County Nursing Home

  • Skilled Nursing Facility
  • White Pine, TN
  • NPI 1982324182
  NPPES parent name

Practitioners 1

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.

• Rual Swanson, MD

  • Family Medicine Physician
  • Dandridge, TN
  • NPI 1174529432
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Rual Swanson, MD

  • Family Medicine Physician
  • Dandridge, TN
  • NPI 1174529432

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188345600000",
    "number": "1285624361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 INDUSTRIAL PARK RD",
            "city": "DANDRIDGE",
            "state": "TN",
            "postal_code": "377254700",
            "telephone_number": "865-397-3163",
            "fax_number": "865-397-4225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 INDUSTRIAL PARK RD",
            "city": "DANDRIDGE",
            "state": "TN",
            "postal_code": "377254700",
            "telephone_number": "865-397-3163",
            "fax_number": "865-397-4225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COUNTY NURSING HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-28",
        "last_updated": "2007-08-29",
        "status": "A",
        "authorized_official_last_name": "MYNATT",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "865-397-3163"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440105",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Lucas James
• Jeffco Drugcenter in Dandridge, Inc.
• Jefferson County Board of Education
• Jefferson County Emergency Medical Serv.
• Jefferson County Hma, LLC (Tennova Healthcare-Rehab Services)
• Madeline Elaine Johnson
• Daniel Joseph Jurek, ATC
• K VA T Food Stores Inc (Food City Pharmacy)
• Jessica Leeann Keen, CPHT
• Jason A. Kennedy, DPT

• Skilled Nursing Facility in Dandridge, TN
• Providers in Dandridge, TN by specialty
• Skilled Nursing Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.