NPIMap

Organization Active NPI

Anew Family Medical PLLC

  • Rural Health Clinic/Center
  • Henderson, TN
National Provider Identifier
1386260792
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 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
Last updated
Oct 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Primary Care Nurse PractitionerGroup: 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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN3 enrollments

Enrollment records 3

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386260792. Details of each certification follow.

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
LLCProprietary
Enrollment address
111 Front St
Henderson, TN 38340-2313

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

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
44D2186775Anew Family Medical, PLLC111 Front Street, Henderson, TN 38340Certificate of waiverJun 21, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

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 InterestCo-Owner May 28, 2020 50%
Corporate OfficerCo-Owner May 28, 2020 50%
W-2 Managing EmployeeCo-Owner May 28, 2020 50%
Operational/Managerial ControlCo-Owner May 28, 2020 50%
Kimberly Roberts Individual 5% Or Greater Direct Ownership InterestCo-Owner May 28, 2020 50%
Corporate OfficerCo-Owner May 28, 2020 50%
W-2 Managing EmployeeCo-Owner May 28, 2020 50%
Operational/Managerial ControlCo-Owner May 28, 2020 50%

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

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

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 & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603756800000",
    "number": "1386260792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 FRONT ST",
            "city": "HENDERSON",
            "state": "TN",
            "postal_code": "383402313",
            "telephone_number": "731-989-2829",
            "fax_number": "731-520-0230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 FRONT ST",
            "city": "HENDERSON",
            "state": "TN",
            "postal_code": "383402313",
            "telephone_number": "731-989-2829",
            "fax_number": "731-520-0230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANEW FAMILY MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-22",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A",
        "authorized_official_last_name": "MOORE-RHODES",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-989-2829"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, TN

Sources for this page

Verify at the official NPI Registry.