NPIMap

Organization Active NPI

Clarksville Health System, LLC

Doing business as Tennova Healthcare-Clarksville

  • General Acute Care Hospital
  • Clarksville, TN
National Provider Identifier
1285689794
Registry record updated Mar 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
000000090 Issued in TN
Legal business name
CLARKSVILLE HEALTH SYSTEM, LLC
Doing business as
Tennova Healthcare-Clarksville
Vanderbilt Clarksville Hospital
Practice address
651 Dunlop LN
Clarksville, TN 37040-5015
Phone
(931) 502-1000
Fax
(931) 502-1215
NPI assigned
May 23, 2006
Last updated
Mar 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2026

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

Authorized official

Name
Cecelia B. Moore
Title
Authorized Official/Treasurer
Phone
(615) 322-0084

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU
Mammography Clinic/Center 261QR0206X NU
Rehabilitation Clinic/Center 261QR0400X NU
General Acute Care Hospital 282N00000X 000000090 TN Primary
Pharmacy 333600000X 147 TN
Institutional Pharmacy 3336I0012X 147 TN

Addresses

Primary practice location

651 Dunlop LN
Clarksville, TN 37040-5015

Mailing address

3841 Green Hills Village Dr Ste 200
Nashville, TN 37215-2691

Other identifiers 1

IdentifierTypeStateIssuer
1000156MedicaidTN

Other names 2

  • Tennova Healthcare-Clarksville Doing business as
  • Vanderbilt Clarksville Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060525000227 TN Part A Provider - Hospital 6305856600 Practice locations: Clarksville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285689794. Details of each certification follow.

Hospital certification: CCN 440035

Legal name
CLARKSVILLE HEALTH SYSTEM, LLC
Doing business as
VANDERBILT CLARKSVILLE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Sep 26, 2018
Beds
270
Ownership / control type
Private (for profit)
Most recent change of ownership
Feb 1, 2006 (3 total)
Organization structure
LLC
Incorporated
Sep 19, 2005 in DE
Enrollment address
651 Dunlop LN
Clarksville, TN 37040-5015
Main/Primary Hospital Location
Hospital subgroups
Acute care, Rehabilitation unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Vanderbilt Clarksville HospitalCCN 440035 · All quality measures
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Clarksville Health System GP3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
John R Ingram Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Cecelia Moore Individual Corporate OfficerTreasurer Feb 1, 2026
Corporate DirectorDirector Dec 31, 2020
Gail Carr Williams Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Vanderbilt Montgomery Holdings LLC Organization, Nashville, TN LLC 5% Or Greater Direct Ownership Interest Dec 31, 2020 100%
John Frederick Stein Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Angela Simmons Individual W-2 Managing EmployeeVice President - Finance Feb 1, 2026
Daniel Diermeier Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Bruce Evans Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Edith Carell Johnson Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Makeba Williams Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Jane Freedman Individual Corporate OfficerPresident Feb 1, 2026
Colin Reed Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Vanderbilt University Medical Center Organization, Nashville, TN Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Dec 31, 2020
Lucinda M Baier Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Sara Finley Individual Corporate DirectorGoverning Board Member Feb 1, 2026
William F. Carpenter Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Randall Davis Individual Corporate OfficerPresident Vanderbilt Clarksville Feb 1, 2026
Raymond D Mefford Individual Corporate OfficerSecretary/General Counsel Feb 1, 2026

Owners & managing parties with NPI records 13

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

View all 13

Facilities with the same owner 19

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

View all 19

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.

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

Affiliated clinicians 470

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

View all 470

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773100800000",
    "number": "1285689794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 GREEN HILLS VILLAGE DR STE 200",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372152691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 DUNLOP LN",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370405015",
            "telephone_number": "931-502-1000",
            "fax_number": "931-502-1215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSVILLE HEALTH SYSTEM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "CECELIA",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL/TREASURER",
        "authorized_official_telephone_number": "615-322-0084"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TN",
            "license": "000000090",
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TN",
            "license": "147",
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "TN",
            "license": "147",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000156",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Tennova Healthcare-Clarksville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vanderbilt Clarksville Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksville, TN

Sources for this page

Verify at the official NPI Registry.