NPIMap

Organization Active NPI

Matthew Walker Comprehensive Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Nashville, TN
National Provider Identifier
1356405278
Registry record updated Feb 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MATTHEW WALKER COMPREHENSIVE HEALTH CENTER, INC
Practice address
1035 14TH Ave N
Nashville, TN 37208
Phone
(615) 327-9400
NPI assigned
Dec 22, 2006
Last updated
Feb 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2022

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

Authorized official

Name
Katina R Beard
Title
Chief Executive Officer
Phone
(615) 327-9400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1035 14TH Ave N
Nashville, TN 37208

Mailing address

1035 14TH Avenue North
Nashville, TN 37208-3050
Phone (615) 340-1292

Other practice location 1

739 President Place
Smyrna, TN 37167-6844
Phone (615) 340-1292

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040702000588 TN Part B Supplier - Clinic/Group Practice 4082691456 Receives reassigned benefits from 25 practitioners
3 other NPIs on this enrollment
Practice locations: Clarksville, TN; Nashville, TN; Smyrna, TN
O20100107000093 TN Part A Provider - Federally Qualified Health Center (FQHC) 4082691456 Practice locations: Nashville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356405278. Details of each certification follow.

Federally qualified health center certification: CCN 441811

Legal name
MATTHEW WALKER COMPREHENSIVE HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jun 23, 1970 in TN
Enrollment address
1035 14TH N Ave
Nashville, TN 37208-3050

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Community Governing Board of Mattew Walker Comprehensive Cente4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

230 Dover Rd
Clarksville, TN 37042
Phone (931) 920-5000

230 Dover Rd
Ste 100
Clarksville, TN 37042

230 Dover Rd
Ste C
Clarksville, TN 37042
Phone (931) 920-5000

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Jerron Barnes Individual Corporate DirectorBoard Director Jan 1, 2017
Andrae Crismon Individual Corporate DirectorBoard Director Jan 1, 2017
Robin Calloway Individual Corporate DirectorHuman Resource Director Dec 3, 2007
Katina R Beard Individual Corporate OfficerChief Executive Officer May 8, 2015
Theodore Jones Individual Corporate OfficerBoard Treasurer Jan 1, 2017
Tera Hambrick Individual W-2 Managing EmployeeLegal Affairs Director Apr 1, 2012
Sandra Long Weaver Individual Corporate DirectorBoard Director Jan 1, 2017
Antoinne Chiari Able Individual Corporate OfficerBoard Chair Aug 1, 2014
Ida Williams Individual W-2 Managing EmployeeMedical Director Apr 1, 2012

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645747200000",
    "number": "1356405278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 14TH AVENUE NORTH",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372083050",
            "telephone_number": "615-340-1292",
            "fax_number": "615-327-2806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 14TH AVE N",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "37208",
            "telephone_number": "615-327-9400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "739 President Place",
            "address_purpose": "LOCATION",
            "city": "Smyrna",
            "state": "TN",
            "postal_code": "371676844",
            "country_code": "US",
            "telephone_number": "615-340-1292",
            "fax_number": "615-327-2806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MATTHEW WALKER COMPREHENSIVE HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A",
        "authorized_official_last_name": "BEARD",
        "authorized_official_first_name": "KATINA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "615-327-9400"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

Verify at the official NPI Registry.