NPIMap

Organization Active NPI

Rural Health Services Consortium of Upper East Tennessee Inc

Doing business as Dry Creek Medical Center

  • Federally Qualified Health Center (FQHC)
  • Erwin, TN
National Provider Identifier
1396745162
Registry record updated Oct 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
Doing business as
Dry Creek Medical Center
Practice address
1826 N Main Ave
Erwin, TN 37650-8932
Phone
(423) 743-6135
Fax
(423) 743-0035
NPI assigned
Jul 22, 2005
Last updated
Oct 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2008

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

Authorized official

Name
Mrs. Linda W Buck
Title
Ceo
Phone
(423) 272-9163

Specialties & licenses 1

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

Addresses

Primary practice location

1826 N Main Ave
Erwin, TN 37650-8932

Mailing address

PO Box 850
Rogersville, TN 37857-0850
Phone (423) 272-9163

Other identifiers 5

IdentifierTypeStateIssuer
3703868OtherCIGNA MEDICARE
020021000OtherBLACKLUNG
002OtherCHAMPUS PROVIDER
4122525OtherTNBLUECROSS BLUESHIELD
4448096MedicaidTN

Other names 1

  • Dry Creek Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031107000207 TN Part B Supplier - Clinic/Group Practice 0941118111 Receives reassigned benefits from 54 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rogersville, TN; Sneedville, TN; Kingsport, TN
O20080929000714 TN Part A Provider - Federally Qualified Health Center (FQHC) 0941118111 Practice locations: Erwin, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396745162. Details of each certification follow.

Federally qualified health center certification: CCN 441813

Legal name
RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 21, 1985 in TN
Enrollment address
1826 N Main Ave
Erwin, TN 37650-8932

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 13

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

View all 13

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
44D0310945Dry Creek Medical Center1826 North Main Avenue, Erwin, TN 37650Certificate of waiverJul 6, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Linda W. Buck Individual Corporate DirectorPresident/Ceo Sep 19, 2008
W-2 Managing Employee Sep 19, 2008
Amelia E Bailey Individual Corporate DirectorBoard Member Mar 25, 2021
Cloyce Eller Individual Corporate DirectorBoard Member Sep 19, 2008
Geren Michael Street Individual Corporate DirectorBoard Member Jul 23, 2020
Minnie Miller Individual Corporate DirectorBoard Memeber Apr 1, 2012
Terry Cunningham Individual Corporate DirectorBoard Member Sep 19, 2008
Jacqueline Charles Individual Corporate DirectorBoard Member Sep 19, 2008
Charles R Huffman Individual Corporate DirectorBoard Member Oct 24, 2019
Joseph Paul Frye Individual Corporate DirectorBoard Member Sep 19, 2008
Timothy R Smithson Individual Corporate DirectorBoard Member Apr 1, 2019
Betty Greene Individual Corporate DirectorBoard Member Sep 19, 2008
Charles Herman Heck Individual Corporate DirectorBoard Member Sep 22, 2016
Lorena Reynoso Individual Corporate DirectorBoard Member Jul 25, 2019

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Rogersville Medical ComplexRogersville, TN, CCN 441960 Federally qualified health center Operational/Managerial Control Dec 30, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223596800000",
    "number": "1396745162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "378570850",
            "telephone_number": "423-272-9163",
            "fax_number": "423-921-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1826 N MAIN AVE",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "376508932",
            "telephone_number": "423-743-6135",
            "fax_number": "423-743-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2008-10-10",
        "status": "A",
        "authorized_official_last_name": "BUCK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "423-272-9163",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA MEDICARE",
            "identifier": "3703868",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACKLUNG",
            "identifier": "020021000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS PROVIDER",
            "identifier": "002",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "4122525",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4448096",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dry Creek Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Erwin, TN

Sources for this page

Verify at the official NPI Registry.