NPIMap

Organization Active NPI

Community Governing Board of Mattew Walker Comprehensive Cente

  • Federally Qualified Health Center (FQHC)
  • Nashville, TN
National Provider Identifier
1386895027
Registry record updated Feb 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY GOVERNING BOARD OF MATTEW WALKER COMPREHENSIVE CENTE
Practice address
904 26TH Ave N
Nashville, TN 37208-3202
Phone
(615) 327-9400
Fax
(615) 327-2806
NPI assigned
Sep 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2022

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

Authorized official

Name
Jeffrey McKissack
Title
Chief Executive Officer
Phone
(615) 340-1292

Specialties & licenses 1

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

Addresses

Primary practice location

904 26TH Ave N
Nashville, TN 37208-3202

Mailing address

1035 14TH Ave N
Nashville, TN 37208-3050
Phone (615) 327-9400

Other identifiers 1

IdentifierTypeStateIssuer
T07209AMedicaidTN

Other names 1

  • Matthew Walker Comprehensive Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040702000588 TN Part B Supplier - Clinic/Group Practice 4082691456 Receives reassigned benefits from 25 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clarksville, TN; Nashville, TN; Smyrna, TN

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Matthew Walker Comprehensive Health Center Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645747200000",
    "number": "1386895027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 14TH AVE N",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372083050",
            "telephone_number": "615-327-9400",
            "fax_number": "615-327-2806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 26TH AVE N",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372083202",
            "telephone_number": "615-327-9400",
            "fax_number": "615-327-2806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY GOVERNING BOARD OF MATTEW WALKER COMPREHENSIVE CENTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-30",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A",
        "authorized_official_last_name": "MCKISSACK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "615-340-1292"
    },
    "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": "T07209A",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Matthew Walker Comprehensive Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Matthew Walker Comprehensive Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nashville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.