BH Services Southeast 1 PC
Organization Active NPI Rural Health Clinic/Center · Brownsville, TN
NPI 1386488922 · NPPES record last updated Dec 4, 2024
Key facts
- NPI
- 1386488922
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- BH SERVICES SOUTHEAST 1 PC
- Practice address
- 2565 N Washington Ave
Brownsville, TN 38012-1610 - Phone
- (731) 772-4199
- NPI assigned
- Jun 19, 2024
- Organization subpart
- No
Authorized official
- Name
- Sandra Bakerink
- Title
- Director, Provider Enrollment/Ao
- Phone
- (865) 500-1325
Owners & managing parties with NPI records 2
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 1
Change of ownership 1
Facilities with the same owner 1
Practitioners 96
-
James D Alberta, M.D.
-
Jennifer Arthur, NP
-
Lindsey C Baxter, AGACNP-BC
-
Keisha Bean, PSYCHOLOGIST
-
Fay Lynn Bembry, NP
-
Zachary Bridges, PA-C
-
Aaron Brude, NP
-
Marian C Bryce, D.O.
-
Raline Center, M.A. EDS
-
Michael Thomas Cox, M.D.
-
Angela Cremeans, APRN
-
Connie Joy Daniel, EDD
-
Steve D. Daugherty, D.O.
-
Morgan Blake Durant, PMHNP-BC
-
Eric Harrison Gandy, FNP-C
-
Mary Ellen Genung, DNP FNP
-
Natascha Haggard, FNP-C
-
Alana Michelle Haney, MPAS,PA-C,RN-C,CDDN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
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
- Corporation · Proprietary
- Incorporated
- Feb 20, 2024 in TN
- Enrollment address
- 2565 N Washington Ave
Brownsville, TN 38012-1610
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Michael David Corvini |
Corporate Officer |
Feb 20, 2024 | |
| Derise M Woods |
Corporate Officer |
Feb 20, 2024 | |
| Southeast Provider Services, LLC |
Operational/Managerial Control | Feb 20, 2024 | |
| Joseph Thompson Crane |
Contracted Managing Employee |
Feb 20, 2024 | 100% |
| 5% Or Greater Direct Ownership Interest |
Feb 20, 2024 | 100% | |
| Corporate Officer |
Feb 20, 2024 | 100% | |
| Sandra Bakerink |
Corporate Officer |
Feb 20, 2024 | |
| John R Stair |
Corporate Officer |
Feb 20, 2024 | |
| Alice Leone |
Corporate Officer |
Feb 20, 2024 | |
| Lara Strand Owens |
Corporate Officer |
Feb 20, 2024 | |
| John P Barrack |
Corporate Officer |
Feb 20, 2024 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Aug 1, 2024 | Change of Ownership |
Brownsville Medical Clinic, P.a. |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240905002009 | TN | Part a Provider - Rural Health Clinic | 7012457054 | Practice locations: Brownsville, TN |
National Provider Directory
- Tax ID family
- BH Services Southeast 1 PC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Nurse Practitioner |
363L00000X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
2565 N Washington Ave
Brownsville, TN 38012-1610
Mailing address
265 Brookview Centre Way Ste 203
Knoxville, TN 37919-4052
Other names
- Brownsville Medical Clinic
Other providers in Brownsville, TN
- Anita C Bailey
- 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
All providers in Brownsville, TN · Rural Health Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.