NPIMap

Organization Active NPI

Ocoee Regional Health Corporation

  • Federally Qualified Health Center (FQHC)
  • Benton, TN
National Provider Identifier
1386857381
Registry record updated Jun 29, 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
Practice address
6784 Highway 411
Benton, TN 37307-0308
Phone
(423) 338-8995
Fax
(423) 338-8996
NPI assigned
May 7, 2007
Last updated
Jun 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Authorized official

Name
Mr. Bill R Moats
Title
Ceo
Phone
(423) 338-8995

Specialties & licenses 1

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

Addresses

Primary practice location

6784 Highway 411
Benton, TN 37307-0308

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
3379622MedicaidTN

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040412001630 TN Part B Supplier - Clinic/Group Practice 1355233693 Receives reassigned benefits from 32 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Decatur, TN; Pikeville, TN; Dayton, TN; Coalmont, TN; Cleveland, TN; Benton, TN
O20210831001715 TN Part A Provider - Federally Qualified Health Center (FQHC) 1355233693 Practice locations: Copperhill, TN
O20220913002373 TN Part A Provider - Federally Qualified Health Center (FQHC) 1355233693 Practice locations: Benton, TN

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1386857381. Details of each certification follow.

Federally qualified health center certification: CCN 441023

Legal name
OCOEE REGIONAL HEALTH CORPORATION
Doing business as
COPPER BASIN ELEMENTARY SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 31, 2021
Last certification
Aug 31, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1978 in TN
Enrollment address
206 Cougar Dr
Copperhill, TN 37317-5001

Federally qualified health center certification: CCN 441011

Legal name
OCOEE REGIONAL HEALTH CORPORATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 13, 2022
Last certification
Sep 13, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1978 in TN
Enrollment address
6784 Highway 411
Benton, TN 37307-4818

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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 EmployeeCeo Jan 1, 1990 100%
Corporate OfficerCeo Jan 1, 1990
Operational/Managerial ControlCeo Jan 1, 1990
Patti Dalton Individual Corporate Director Jan 1, 2009
Evelio Hidalgo-Barrionuevo Individual Corporate Director May 27, 2021
Pearson Devaul Individual Corporate OfficerCoo Jan 1, 2019
Linda Davis Individual Corporate Director Jan 1, 1990
Bill Hollin Individual Corporate Director Jan 1, 1995
Chandler Blakely Individual Corporate OfficerCfo 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
Charles Ross Individual Corporate DirectorBoard of Director Jun 1, 2022

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.

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1386857381",
    "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": "6784 HIGHWAY 411",
            "city": "BENTON",
            "state": "TN",
            "postal_code": "373070308",
            "telephone_number": "423-338-8995",
            "fax_number": "423-338-8996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCOEE REGIONAL HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "MOATS",
        "authorized_official_first_name": "BILL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "423-338-8995",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3379622",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, TN

Sources for this page

Verify at the official NPI Registry.