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Anew Family Medical PLLC

Organization Active NPI Rural Health Clinic/Center · Henderson, TN

NPI 1386260792 · NPPES record last updated Oct 27, 2020

Key facts

NPI
1386260792
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
ANEW FAMILY MEDICAL PLLC
Practice address
111 Front St
Henderson, TN 38340-2313
Phone
(731) 989-2829
Fax
(731) 520-0230
NPI assigned
Jun 22, 2020
Organization subpart
No

Authorized official

Name
Katherine N Moore-Rhodes
Title
Owner
Phone
(731) 989-2829

Owners & managing parties with NPI records 1

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

  • Kimberly S Roberts, FNP Family Nurse Practitioner · Henderson, TN · NPI 1407210685
    CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST · CORPORATE OFFICER · OPERATIONAL/MANAGERIAL CONTROL · W-2 MANAGING EMPLOYEE

Other NPIs on the same Medicare enrollment 2

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

Other NPIs with the same Medicare PAC ID 1

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners 12

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2186775Anew Family Medical, PLLC
111 Front Street, Henderson, TN 38340		Certificate of waiverJun 21, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (3 enrollments) in TN

Rural health clinic certification: CCN 883828

Legal name
ANEW FAMILY MEDICAL PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 29, 2020
Last certification
Nov 25, 2025
Ownership / control type
1C
Organization structure
LLC · Proprietary
Enrollment address
111 Front St
Henderson, TN 38340-2313

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Katherine Moore-Rhodes
Individual 		5% Or Greater Direct Ownership Interest
Co-Owner		 May 28, 2020 50%
Corporate Officer
Co-Owner		 May 28, 2020 50%
W-2 Managing Employee
Co-Owner		 May 28, 2020 50%
Operational/Managerial Control
Co-Owner		 May 28, 2020 50%
Kimberly Roberts
Individual 		5% Or Greater Direct Ownership Interest
Co-Owner		 May 28, 2020 50%
Corporate Officer
Co-Owner		 May 28, 2020 50%
W-2 Managing Employee
Co-Owner		 May 28, 2020 50%
Operational/Managerial Control
Co-Owner		 May 28, 2020 50%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20200617003057 TN Part B Supplier - Clinic/Group Practice 7911329073 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Henderson, TN; Jackson, TN
O20200826000169 TN Part a Provider - Rural Health Clinic 7012334873 Practice locations: Henderson, TN
O20200924003093 TN Part B Supplier - Clinic/Group Practice 7012334873 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: Henderson, TN; Middleton, TN

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes
Primary Care Nurse Practitioner
Group: 193400000X SINGLE SPECIALTY GROUP		 363LP2300X

Addresses

Primary practice location

111 Front St
Henderson, TN 38340-2313

Mailing address

111 Front St
Henderson, TN 38340-2313
Phone (731) 989-2829

Other providers in Henderson, TN

All providers in Henderson, TN · Rural Health Clinic/Center in Tennessee

Sources for this page

Verify at the official NPI Registry.