Individual provider Active NPI

Chelsey Johnson Sparks, APRN-BC

  • Family Nurse Practitioner
  • Decaturville, TN
National Provider Identifier
1295008795
Registry record updated Jul 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
16496 Issued in TN
Practice address
187 W Main St
Decaturville, TN 38329-8078
Phone
(731) 852-2761
Fax
(731) 852-2781
NPI assigned
Feb 14, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 16496 TN Primary

Addresses

Primary practice location

187 W Main St
Decaturville, TN 38329-8078

Mailing address

115 E Brooklyn St
P O Box 916
Linden, TN 37096-3515
Phone (931) 589-2104

Other identifiers 1

IdentifierTypeStateIssuer
1528159MedicaidTN

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

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 profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
May accept Medicare assignment
Group practices
Chelsey Sparks Dba Decaturville Family Practice 5 clinicians

Practice addresses (Care Compare)

187 W Main St
Decaturville, TN 38329-8078
Phone (731) 852-2761

Hospital & facility affiliations

  • Volunteer Homecare of West TN Home health agency, Parsons, TN, CCN 447561
  • Tennessee Quality Care - Home Health Home health agency, Parsons, TN, CCN 447402
  • Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002
  • Henderson County Community Hospital Hospital, Lexington, TN, CCN 440008
  • West Tennessee Healthcare Camden Hospital Hospital, Camden, TN, CCN 441316
  • Hardin Medical Center Hospital, Savannah, TN, CCN 440109

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120425000774 TN Practitioner - Nurse Practitioner 9830351576 Reassigns benefits to 1 organization
O20200526001526 TN Part A Provider - Rural Health Clinic 3971872284 Practice locations: Decaturville, TN

Rural health clinic certification: CCN 883826

Legal name
CHELSEY SPARKS DBA DECATURVILLE FAMILY PRACTICE
Doing business as
DECATURVILLE FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 9, 2020
Last certification
Mar 3, 2026
Ownership / control type
1A
Organization structure
Sole ProprietorProprietary
Enrollment address
187 W Main St
Decaturville, TN 38329-8078

All disclosed owners & managing parties 2

Medicare enrollment files

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

NameRoleSinceShare
Andrew Sparks Individual 5% Or Greater Direct Ownership Interest Jul 1, 2017 50%
Corporate OfficerOwner Jul 1, 2017
W-2 Managing Employee Jul 1, 2017
Chelsey Johnson Sparks Individual 5% Or Greater Direct Ownership Interest Jul 1, 2017 50%
Corporate OfficerOwner Jul 1, 2017

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
16496TNMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1329177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594339200000",
    "number": "1295008795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 E BROOKLYN ST",
            "address_2": "P O BOX 916",
            "city": "LINDEN",
            "state": "TN",
            "postal_code": "370963515",
            "telephone_number": "931-589-2104",
            "fax_number": "931-589-2513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 W MAIN ST",
            "city": "DECATURVILLE",
            "state": "TN",
            "postal_code": "383298078",
            "telephone_number": "731-852-2761",
            "fax_number": "731-852-2781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPARKS",
        "first_name": "CHELSEY",
        "middle_name": "JOHNSON",
        "credential": "APRN-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-02-14",
        "last_updated": "2020-07-10",
        "certification_date": "2020-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "16496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528159",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decaturville, TN

Sources for this page

Verify at the official NPI Registry.