NPIMap

Organization Active NPI

Ocoee Regional Health Corporation

Doing business as Graysville Elementary School

  • Federally Qualified Health Center (FQHC)
  • Dayton, TN
National Provider Identifier
1376116541
Registry record updated Jul 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OCOEE REGIONAL HEALTH CORPORATION
Doing business as
Graysville Elementary School
Practice address
3900 Double S Rd
Dayton, TN 37321-5344
Phone
(423) 338-8995
NPI assigned
Jul 23, 2021
Last updated
Jul 23, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
OCOEE REGIONAL HEALTH CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 23, 2021

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

Authorized official

Name
William Moats
Title
President/Ceo
Phone
(423) 338-8995

Specialties & licenses 1

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

Addresses

Primary practice location

3900 Double S Rd
Dayton, TN 37321-5344

Mailing address

PO Box 308
Benton, TN 37307-0308
Phone (423) 338-8995

Other names 1

  • Graysville Elementary School Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210831002105 TN Part A Provider - Federally Qualified Health Center (FQHC) 1355233693 Practice locations: Dayton, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376116541. Details of each certification follow.

Federally qualified health center certification: CCN 441012

Legal name
OCOEE REGIONAL HEALTH CORPORATION
Doing business as
GRAYSVILLE ELEMENTARY SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 19, 2021
Last certification
Aug 19, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1978 in TN
Enrollment address
606 Long St
Dayton, TN 37321-7512

Other NPIs with the same Medicare PAC ID 11

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2175262Graysville Elementary School606 Long Street, Dayton, TN 37321Certificate of waiverNov 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ocoee Regional Health C14 organizations share this tax ID, including this one
Part of
Ocoee Regional Health C

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Kimberly Bishop Individual Corporate Director Jan 1, 1997
Ruth Creasman Individual Corporate Director Jan 1, 1992
William Moats Individual Corporate OfficerCeo Jan 1, 1990 100%
W-2 Managing Employee Jan 1, 1990 100%
Patti Dalton Individual Corporate Director Jan 1, 2008
Evelio Hidalgo-Barrionuevo Individual Corporate Director May 27, 2021
Pearson Devaul Individual Corporate DirectorCoo Jan 1, 2019
Linda Davis Individual Corporate Director Jan 1, 1990
Bill Hollin Individual Corporate Director Jan 1, 1995
Chandler Blakely Individual Corporate Officer Mar 1, 2021
Judy Reynolds Individual Corporate Director Jan 1, 2015
Rita Hammons Individual Corporate Director Jan 1, 2000
John Myers Individual Corporate Director Apr 1, 2015
Nelson Cope Individual Corporate Director Jan 1, 2019

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Benton Family Health Care CenterBenton, TN, CCN 441817 Federally qualified health center Operational/Managerial Control Jul 1, 1978
Grundy County Primary Care CenterCoalmont, TN, CCN 441867 Federally qualified health center Operational/Managerial Control Jan 1, 1990

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626998400000",
    "number": "1376116541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 308",
            "city": "BENTON",
            "state": "TN",
            "postal_code": "373070308",
            "telephone_number": "423-338-8995",
            "fax_number": "423-338-8996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 DOUBLE S RD",
            "city": "DAYTON",
            "state": "TN",
            "postal_code": "373215344",
            "telephone_number": "423-338-8995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCOEE REGIONAL HEALTH CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OCOEE REGIONAL HEALTH CORPORATION",
        "enumeration_date": "2021-07-23",
        "last_updated": "2021-07-23",
        "certification_date": "2021-06-28",
        "status": "A",
        "authorized_official_last_name": "MOATS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "423-338-8995"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graysville Elementary School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dayton, TN

Sources for this page

Verify at the official NPI Registry.