NPIMap

Organization Active NPI

Vanderbilt Integrated Providers, LLC

  • Rural Health Clinic/Center
  • Hopkinsville, KY
National Provider Identifier
1356936744
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
VANDERBILT INTEGRATED PROVIDERS, LLC
Practice address
4235 Fort Campbell Blvd
Hopkinsville, KY 42240-9339
Phone
(270) 560-0075
NPI assigned
Mar 8, 2021
Organization subpart
No

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
Wendy Monaci
Title
Vice President
Phone
(615) 936-3944

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Rural Health Clinic/Center 261QR1300X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X

Addresses

Primary practice location

4235 Fort Campbell Blvd
Hopkinsville, KY 42240-9339

Mailing address

3841 Green Hills Village Dr Ste 200
Nashville, TN 37215-2691

Other names 1

  • Vanderbilt Pediatric Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210329002121 KY Part A Provider - Rural Health Clinic 7012817919 Practice locations: Hopkinsville, KY

Rural health clinic certification: CCN B03840

Legal name
VANDERBILT INTEGRATED PROVIDERS LLC
Doing business as
VANDERBILT PEDIATRIC ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 14, 2021
Last certification
Jul 2, 2024
Ownership / control type
2B
Organization structure
LLCNon-profit
Incorporated
Sep 1, 2020 in TN
Enrollment address
4235 Fort Campbell Blvd
Hopkinsville, KY 42240-9339

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Rebecca Morgan6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

719 Thompson Ln
Ste 30330
Nashville, TN 37204
Phone (615) 936-3871

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Karen Nanney Individual Corporate OfficerSecretary/Treasurer May 1, 2021
Jane Freedman Individual W-2 Managing EmployeeChief Health Systems Officer Jul 1, 2025
Wendy Monaci Individual Corporate OfficerVP May 2, 2021
W-2 Managing Employee May 1, 2021
Vanderbilt University Medical Center Organization, Nashville, TN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2020 100%
Rick W Wright Individual Corporate OfficerPresident Jul 1, 2025

Owners & managing parties with NPI records 13

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

View all 13

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Vip Children'S Clinic-LafayetteLafayette, TN, CCN 883850 Rural health clinic 5% Or Greater Indirect Ownership Interest Jul 1, 1998
Vip Children'S Clinic - SpringfieldSpringfield, TN, CCN 883849 Rural health clinic Limited Partnership Interest Jul 1, 1998
Vip Childrens Clinic-Pleasant ViewPleasant View, TN, CCN 883848 Rural health clinic Limited Partnership Interest Jul 1, 1998

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 19

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

View all 19

Practitioners & affiliated clinicians

Practitioners 82

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 82

NPI Registry JSON

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

{
    "created_epoch": "1615161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1356936744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 GREEN HILLS VILLAGE DR STE 200",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372152691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4235 FORT CAMPBELL BLVD",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422409339",
            "telephone_number": "270-560-0075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANDERBILT INTEGRATED PROVIDERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-08",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "MONACI",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-936-3944"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vanderbilt Pediatric Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hopkinsville, KY

Sources for this page

Verify at the official NPI Registry.