NPIMap

Organization Active NPI

Upper Cumberland Rural Health Clinic PLLC

Doing business as Cookeville Medical Clinic RHC

  • Rural Health Clinic/Center
  • Cookeville, TN
National Provider Identifier
1346388246
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
443916 Issued in TN
Legal business name
UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC
Doing business as
Cookeville Medical Clinic RHC
Practice address
225 N Willow Ave Ste 3
Cookeville, TN 38501-2453
Phone
(931) 528-8899
Fax
(866) 449-4618
NPI assigned
Feb 2, 2007
Last updated
Feb 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

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

Authorized official

Name
Dr. 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 with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X 443916 TN Primary

Addresses

Primary practice location

225 N Willow Ave Ste 3
Cookeville, TN 38501-2453

Mailing address

225 N Willow Ave
Cookeville, TN 38501-2335
Phone (931) 528-8899

Other names 1

  • Cookeville 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
O20070716000020 TN Part A Provider - Rural Health Clinic 8820198138 Practice locations: Cookeville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346388246. Details of each certification follow.

Rural health clinic certification: CCN 443916

Legal name
UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 13, 1996
Last certification
Jul 17, 2019
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
Nov 28, 1995 in TN
Enrollment address
225 N Willow Ave
Ste 3
Cookeville, TN 38501-2335

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

802 N Main St
Crossville, TN 38555

820 N Main St
Crossville, TN 38555
Phone (931) 250-5230

402 E Gore Ave
Gainesboro, TN 38562
Phone (931) 268-6800

Ownership & related parties

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.

NameRoleSinceShare
Cookeville Intermediate, PA Organization, Cookeville, TN Corporation 5% Or Greater Direct Ownership Interest Apr 28, 2023 100%
Pushpendra K Jain Individual 5% Or Greater Indirect Ownership Interest Apr 28, 2023 100%
Corporate Director Nov 28, 1995
Alexis Barbour Individual Corporate Director Apr 28, 2023
Navin Jain Individual Corporate DirectorPractice Administrator Feb 5, 2019
W-2 Managing Employee Feb 5, 2019

Owners & managing parties with NPI records 1

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1346388246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 N WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012335",
            "telephone_number": "931-528-8899",
            "fax_number": "931-284-4085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N WILLOW AVE STE 3",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012453",
            "telephone_number": "931-528-8899",
            "fax_number": "866-449-4618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "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_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TN",
            "license": "443916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cookeville Medical Clinic RHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.