WT Medical Associates

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

WT MEDICAL ASSOCIATES

Doing business as

West Tennessee Medical Group Primary Care Camden

Practice address

186 Hospital Dr
Camden, TN 38320-1618

Phone

(731) 593-6260

Fax

(731) 256-9860

NPI assigned

Jul 19, 2023

Last updated

Jul 19, 2023By 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

Bartley Teague

Title

Executive Director Revenue Cycle

Phone

(731) 512-1277

Specialties & licenses 2

Addresses

Other names 1

• West Tennessee Medical Group Primary Care Camden Doing business as

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356021026. Details of each certification follow.

• CCN 883957 Rural health clinic · Active · Details

Rural health clinic certification: CCN 883957

Legal name

WT MEDICAL ASSOCIATES

Doing business as

WEST TENNESSEE MEDICAL GROUP PRIMARY CARE CAMDEN

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Mar 12, 2024

Last certification

Mar 12, 2024

Ownership / control type

2B

Organization structure

CorporationNon-profit

Enrollment address

186 Hospital Dr
Camden, TN 38320-1618

Other NPIs with the same Medicare PAC ID 4

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

• WT Medical Associates

  • Internal Medicine Physician
  • Dyersburg, TN
  • NPI 1295223279

  1951650613

  Same PAC ID
• WT Medical Associates

  dba West Tennessee Medical Group Pediatrics Paris Henry C

  • Rural Health Clinic/Center
  • Paris, TN
  • NPI 1316496029

  1951650613

  Same PAC ID
• WT Medical Associates

  dba West Tennessee Medical Group Primary Care Halls

  • Rural Health Clinic/Center
  • Halls, TN
  • NPI 1356176556

  1951650613

  Same PAC ID
• WT Medical Associates

  dba West Tennessee Medical Group Primary Care & Women's Health

  • Rural Health Clinic/Center
  • Dyersburg, TN
  • NPI 1427604198

  1951650613

  Same PAC ID

Other NPIs on the same Medicare enrollment 3

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

• WT Medical Associates

  • Internal Medicine Physician
  • Dyersburg, TN
  • NPI 1295223279

  O20180814002772

  Same enrollment
• WT Medical Associates

  dba West Tennessee Medical Group Pediatrics Paris Henry C

  • Rural Health Clinic/Center
  • Paris, TN
  • NPI 1316496029

  O20180814002772

  Same enrollment
• WT Medical Associates

  dba West Tennessee Medical Group Primary Care & Women's Health

  • Rural Health Clinic/Center
  • Dyersburg, TN
  • NPI 1427604198

  O20180814002772

  Same enrollment

Tax ID family

WT Medical Associates3 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.

• WT Medical Associates

  dba West Tennessee Medical Group Pediatrics Paris Henry C

  • Rural Health Clinic/Center
  • Paris, TN
  • NPI 1316496029
  NPD tax ID
• WT Medical Associates

  dba West Tennessee Medical Group Primary Care Halls

  • Rural Health Clinic/Center
  • Halls, TN
  • NPI 1356176556
  NPD tax ID

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.

Owners & managing parties with NPI records 4

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

• WT Medical Associates

  • Internal Medicine Physician
  • Dyersburg, TN
  • NPI 1295223279

  5% Or Greater Direct Ownership Interest

  CMS ownership
• WT Medical Associates

  dba West Tennessee Medical Group Pediatrics Paris Henry C

  • Rural Health Clinic/Center
  • Paris, TN
  • NPI 1316496029

  5% Or Greater Direct Ownership Interest

  CMS ownership
• WT Medical Associates

  dba West Tennessee Medical Group Primary Care Halls

  • Rural Health Clinic/Center
  • Halls, TN
  • NPI 1356176556

  5% Or Greater Direct Ownership Interest

  CMS ownership
• WT Medical Associates

  dba West Tennessee Medical Group Primary Care & Women's Health

  • Rural Health Clinic/Center
  • Dyersburg, TN
  • NPI 1427604198

  5% Or Greater Direct Ownership Interest

  CMS ownership

All facility ownership & control disclosures 2

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

Owned or controlled facilities with NPI records 2

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

• WT Medical Associates

  dba West Tennessee Medical Group Pediatrics Paris Henry C

  • Rural Health Clinic/Center
  • Paris, TN
  • NPI 1316496029

  5% Or Greater Direct Ownership Interest

  CMS ownership
• WT Medical Associates

  dba West Tennessee Medical Group Primary Care & Women's Health

  • Rural Health Clinic/Center
  • Dyersburg, TN
  • NPI 1427604198

  5% Or Greater Direct Ownership Interest

  CMS ownership

Facilities with the same owner 2

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

• WT Medical Associates

  dba West Tennessee Medical Group Pediatrics Paris Henry C

  • Rural Health Clinic/Center
  • Paris, TN
  • NPI 1316496029

  WT Medical Associates

  CMS ownership
• WT Medical Associates

  dba West Tennessee Medical Group Primary Care & Women's Health

  • Rural Health Clinic/Center
  • Dyersburg, TN
  • NPI 1427604198

  WT Medical Associates

  CMS ownership

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

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689724800000",
    "number": "1356021026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013923",
            "telephone_number": "731-541-5000",
            "fax_number": "731-541-6802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 HOSPITAL DR",
            "city": "CAMDEN",
            "state": "TN",
            "postal_code": "383201618",
            "telephone_number": "731-593-6260",
            "fax_number": "731-256-9860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WT MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-19",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A",
        "authorized_official_last_name": "TEAGUE",
        "authorized_official_first_name": "BARTLEY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR REVENUE CYCLE",
        "authorized_official_telephone_number": "731-512-1277"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Tennessee Medical Group Primary Care Camden",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Janet Warren, RD
• Victoria Watson, MD
• Sherry H Whiteside, L.P.C., MHSP
• Whitney Wilbanks, LPC-MHSP
• Jon R Winter, DO
• Susan Elizabeth Yeomans, PNP-BC

• Rural Health Clinic/Center in Camden, TN
• Providers in Camden, TN by specialty
• Rural Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.