BH Services Southeast 1 PC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

BH SERVICES SOUTHEAST 1 PC

Doing business as

Brownsville Medical Clinic

Practice address

2565 N Washington Ave
Brownsville, TN 38012-1610

Phone

(731) 772-4199

NPI assigned

Jun 19, 2024

Last updated

Dec 4, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sandra Bakerink

Title

Director, Provider Enrollment/Ao

Phone

(865) 500-1325

Specialties & licenses 3

Addresses

Other names 1

• Brownsville Medical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386488922. Details of each certification follow.

• CCN 883810 Rural health clinic · Active · Details

Rural health clinic certification: CCN 883810

Legal name

BH SERVICES SOUTHEAST 1 PC

Doing business as

BROWNSVILLE MEDICAL CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Mar 11, 2020

Last certification

Nov 25, 2025

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Feb 20, 2024 in TN

Enrollment address

2565 N Washington Ave
Brownsville, TN 38012-1610

Other NPIs with the same Medicare PAC ID 2

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

• BH Services Southeast 1 PC

  • Nurse Practitioner
  • Brownsville, TN
  • NPI 1164251526

  7012457054

  Same PAC ID
• BH Services Southeast 1 PC

  dba Medical Clinic of Alamo

  • Rural Health Clinic/Center
  • Alamo, TN
  • NPI 1568200806

  7012457054

  Same PAC ID

Tax ID family

BH Services Southeast 1 PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• BH Services Southeast 1 PC

  dba Medical Clinic of Alamo

  • Rural Health Clinic/Center
  • Alamo, TN
  • NPI 1568200806
  NPD tax ID

Locations

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.

Owners & managing parties with NPI records 2

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

• Michael D Corvini, MD

  • Emergency Medicine Physician
  • Yonkers, NY
  • NPI 1396770699

  Corporate Officer

  CMS ownership
• Joseph Thompson Crane, MD

  • Emergency Medicine Physician
  • Sunrise, FL
  • NPI 1760420236

  5% Or Greater Direct Ownership Interest, Contracted Managing Employee, Corporate Officer

  CMS ownership

Facilities with the same owner 1

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

• BH Services Southeast 1 PC

  dba Medical Clinic of Alamo

  • Rural Health Clinic/Center
  • Alamo, TN
  • NPI 1568200806

  Southeast Provider Services, LLC

  CMS ownership

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Brownsville Medical Clinic, P.a.

  • Family Medicine Physician
  • Brownsville, TN
  • NPI 1659447696

  Acquired from, 2024-08-01

  CMS change of ownership

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

{
    "created_epoch": "1718755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1386488922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 BROOKVIEW CENTRE WAY STE 203",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379194052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2565 N WASHINGTON AVE",
            "city": "BROWNSVILLE",
            "state": "TN",
            "postal_code": "380121610",
            "telephone_number": "731-772-4199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BH SERVICES SOUTHEAST 1 PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-19",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "BAKERINK",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "DIRECTOR, PROVIDER ENROLLMENT/AO",
        "authorized_official_telephone_number": "865-500-1325"
    },
    "taxonomies": [
        {
            "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
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brownsville Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anita C Bailey, RN
• Janice Ballard
• Sandra K Barnett
• Bethany Home Health Care LLC
• BH Services Southeast 1 PC
• Elizabeth Bird
• Brownsville Apothecary
• Brownsville Apothecary, Inc.
• Brownsville Clinic Corp
• Brownsville Family Medicine, PA

• Rural Health Clinic/Center in Brownsville, TN
• Providers in Brownsville, TN by specialty
• Rural Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.