NPIMap

Organization Active NPI

Campbell County Hma LLC

Doing business as Tennova LaFollette Medical Center Clinic

  • Rural Health Clinic/Center
  • La Follette, TN
National Provider Identifier
1407838261
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
0000000008 Issued in TN
Legal business name
CAMPBELL COUNTY HMA LLC
Doing business as
Tennova LaFollette Medical Center Clinic
Practice address
905 E Central Ave
Lafollette, TN 37766-2055
Phone
(423) 907-1600
Fax
(423) 907-1646
NPI assigned
Nov 17, 2005
Last updated
Mar 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Authorized official

Name
Paula M Lalor
Title
Director/Delegated Official
Phone
(629) 215-3953

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 0000000008 TN Primary

Addresses

Primary practice location

905 E Central Ave
Lafollette, TN 37766-2055

Mailing address

905 E Central Ave
La Follette, TN 37766-2768
Phone (423) 907-1600

Other names 1

  • Tennova LaFollette Medical Center Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111019000020 TN Part B Supplier - Clinic/Group Practice 3173795168 Receives reassigned benefits from 12 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Caryville, TN; Clinton, TN; La Follette, TN; Lafollette, TN
O20111121000379 TN Part A Provider - Rural Health Clinic 3173795168 Practice locations: La Follette, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407838261. Details of each certification follow.

Rural health clinic certification: CCN 443997

Legal name
CAMPBELL COUNTY HMA LLC
Doing business as
TENNOVA LAFOLLETTE MEDICAL CENTER CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 1, 1994
Last certification
Oct 15, 2018
Ownership / control type
1B
Most recent change of ownership
Oct 1, 2011 (2 total)
Organization structure
LLCProprietary
Incorporated
Jun 10, 2011 in TN
Enrollment address
905E Central Ave a
La Follette, TN 37766-2768
Related CCNs
440033

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Campbell County Hma LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the 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
Ronald Cain Individual W-2 Managing EmployeeCeo Jan 27, 2014
Kevin J Hammons Individual Corporate OfficerPresident/Board Member Jan 27, 2014
Corporate DirectorPresident/Board Member Jan 1, 2020
Nathaniel K Summar Individual Corporate DirectorVP Revenue Management Jul 14, 2017
Justin D Pitt Individual Corporate OfficerExec VP/Assist Sec/Board Member Mar 1, 2022
Corporate DirectorExec VP/Assist Sec/Board Member Mar 1, 2022
Health Management Associates LLC Organization, Franklin, TN LLC 5% Or Greater Direct Ownership Interest Dec 31, 2016 100%
William Bradley Cash Individual Corporate OfficerExec VP Jun 1, 2018
Hma-Tri Holdings LLC Organization, Franklin, TN LLC 5% Or Greater Indirect Ownership Interest Dec 31, 2015 100%
Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Jan 27, 2014
Jason Kevin Johnson Individual Corporate OfficerSenior VP Jan 6, 2020
Roman Gabriel Ottinger Individual Corporate OfficerSenior VP/Treasurer Jan 6, 2020
Paula M Lalor Individual Corporate DirectorDelegated Official Apr 1, 2017
Edna S Buffington-Price Individual Corporate DirectorVP/Authorized Official Mar 1, 2022
Christopher G Cobb Individual Corporate OfficerVP/Secretary Apr 1, 2017
CHS Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Apr 27, 2014

Facilities with the same owner 120

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

  • Campbell County Hma LLC
    • Skilled Nursing Facility
    • La Follette, TN
    • NPI 1023099447

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Campbell County Hma LLC

    dba Tennova Primary Care Caryville

    • Rural Health Clinic/Center
    • Caryville, TN
    • NPI 1023613361

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Campbell County Hma LLC

    dba Tennova Primary Care Clinton

    • Rural Health Clinic/Center
    • Clinton, TN
    • NPI 1093300717

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Campbell County Hma LLC
    • Rural Health Clinic/Center
    • La Follette, TN
    • NPI 1639183353

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Campbell County Hma, LLC

    dba Tennova Healthcare-LaFollette Medical Center

    • Psychiatric Hospital Unit
    • La Follette, TN
    • NPI 1548241953

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Campbell County Hma, LLC

    dba Tennova Healthcare-LaFollette Medical Center

    • General Acute Care Hospital
    • La Follette, TN
    • NPI 1639151301

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Campbell County Hma, LLC

    dba Tennova Healthcare-LaFollette Medical Center

    • Medicare Defined Swing Bed Hospital Unit
    • La Follette, TN
    • NPI 1831171693

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Cocke County Hma, LLC

    dba Tennova Healthcare-Newport Medical Center

    • General Acute Care Hospital
    • Newport, TN
    • NPI 1972576247

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Jefferson County Hma LLC

    dba Tennova Healthcare-Jefferson Memorial Hospital

    • General Acute Care Hospital
    • Jefferson City, TN
    • NPI 1972585347

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Metro Knoxville Hma LLC

    dba Tennova Healthcare North Knoxville Medical Center

    • General Acute Care Hospital
    • Powell, TN
    • NPI 1043292899

    CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Hma-Tri Holdings LLC

    CMS ownership
  • Affinity Hospital LLC

    dba Grandview Medical Center

    • General Acute Care Hospital
    • Birmingham, AL
    • NPI 1023061405

    CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC

    CMS ownership
  • Affinity Hospital LLC

    dba Grandview Medical Center

    • Psychiatric Hospital Unit
    • Birmingham, AL
    • NPI 1043263221

    CHS Community Health Systems Inc, Community Health Systems Inc, Hma-Tri Holdings LLC

    CMS ownership
View all 120

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1407838261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 E CENTRAL AVE",
            "city": "LA FOLLETTE",
            "state": "TN",
            "postal_code": "377662768",
            "telephone_number": "423-907-1600",
            "fax_number": "423-907-1646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 E CENTRAL AVE",
            "city": "LAFOLLETTE",
            "state": "TN",
            "postal_code": "377662055",
            "telephone_number": "423-907-1600",
            "fax_number": "423-907-1646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMPBELL COUNTY HMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-17",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "LALOR",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "629-215-3953"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TN",
            "license": "0000000008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tennova LaFollette Medical Center Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tennova LaFollette Medical Center Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Follette, TN

Sources for this page

Verify at the official NPI Registry.