NPIMap

Organization Active NPI

State of Tennessee State F & a Payroll

Doing business as Moccasin Bend Mental Health Institute

  • Psychiatric Hospital Unit
  • Chattanooga, TN
National Provider Identifier
1306818265
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
STATE OF TENNESSEE STATE F & A PAYROLL
Doing business as
Moccasin Bend Mental Health Institute
Practice address
100 Moccasin Bend Rd
Chattanooga, TN 37405-4415
Phone
(423) 265-2271
Fax
(423) 875-3454
NPI assigned
Feb 6, 2006
Last updated
Mar 31, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF TENNESSEEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Authorized official

Name
Mr. Rodney Henderson
Title
Administrator
Phone
(423) 785-3321

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X NU Primary

Addresses

Primary practice location

100 Moccasin Bend Rd
Chattanooga, TN 37405-4415

Mailing address

100 Moccasin Bend Rd
Chattanooga, TN 37405-4415
Phone (423) 265-2271

Other identifiers 1

IdentifierTypeStateIssuer
3282227MedicaidTN

Other names 1

  • Moccasin Bend Mental Health Institute Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031104000309 TN Part B Supplier - Clinic/Group Practice 5698687077 Receives reassigned benefits from 91 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Springfield, TN; Nashville, TN; Memphis, TN; Lebanon, TN; Cookeville, TN; Columbia, TN; Chattanooga, TN; Jackson, TN
O20070115000057 TN Part A Provider - Hospital 5698687077 Practice locations: Chattanooga, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306818265. Details of each certification follow.

Hospital certification: CCN 444002

Legal name
STATE OF TENNESSEE
Doing business as
MOCCASIN BEND MENTAL HEALTH INSTITUTE
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 1, 1966
Last certification
Apr 28, 2004
Beds
172
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
100 Moccasin Bend Road
Chattanooga, TN 37405-4415
Other Hospital Practice Location
Hospital subgroups
Psychiatric unit, Rehabilitation unit

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Moccasin Bend Mental Health InstituteCCN 444002 · All quality measures
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Part of
Loudon County Health de

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
State of Tennessee Organization, Chattanooga, TN Operational/Managerial Control Jul 1, 2008 100%
Rodney Henderson Individual Corporate DirectorPsychiatric Hospital Administrator Aug 10, 2021
Sylvia Harris Individual W-2 Managing EmployeeAccounting Manager, Mbmhi Jun 1, 2010

All facility ownership & control disclosures 17

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

FacilityTypeRoleSince
Middle Tennessee Mental Health InstituteNashville, TN, CCN 444014 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1995
Stewart County Community Medical CenterDover, TN, CCN 441848 Federally qualified health center Operational/Managerial Control (100%) Feb 19, 1987
Overton County Health DepartmentLivingston, TN, CCN 441840 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Cannon County Health DepartmentWoodbury, TN, CCN 441828 Federally qualified health center Other Apr 23, 2014
Clay County Health DepartmentCelina, TN, CCN 441831 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Cumberland County Health DepartmentCrossville, TN, CCN 441832 Federally qualified health center Other Apr 23, 2014
Dekalb County Health DepartmentSmithville, TN, CCN 441834 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Fentress County Health DepartmentJamestown, TN, CCN 441835 Federally qualified health center Other Apr 23, 2014
Jackson County Health DepartmentGainesboro, TN, CCN 441837 Federally qualified health center Other Apr 23, 2014
Macon County Health DepartmentLafayette, TN, CCN 441838 Federally qualified health center Other Apr 23, 2014
Pickett County Health DepartmentByrdstown, TN, CCN 441841 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Putnam County Health DepartmentCookeville, TN, CCN 441842 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Smith County Health DepartmentCarthage, TN, CCN 441843 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Van Buren County Health DepartmentSpencer, TN, CCN 441844 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Warren County Health DepartmentMcMinnville, TN, CCN 441845 Federally qualified health center Other Apr 23, 2014
White County Health DepartmentSparta, TN, CCN 441847 Federally qualified health center Other Apr 23, 2014
Gibson County Health Department/Community Health CenterTrenton, TN, CCN 441968 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2015

Facilities with the same owner 10

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

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1306818265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MOCCASIN BEND RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374054415",
            "telephone_number": "423-265-2271",
            "fax_number": "423-875-3454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MOCCASIN BEND RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374054415",
            "telephone_number": "423-265-2271",
            "fax_number": "423-875-3454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE STATE F & A PAYROLL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF TENNESSEE",
        "enumeration_date": "2006-02-06",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "423-785-3321",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3282227",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moccasin Bend Mental Health Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Moccasin Bend Mental Health Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.