NPIMap

Organization Active NPI

Amg-Crockett, LLC

Doing business as Southern Tennessee Internal Medicine - Lawrenceburg

  • Rural Health Clinic/Center
  • Lawrenceburg, TN
National Provider Identifier
1417739640
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
AMG-CROCKETT, LLC
Doing business as
Southern Tennessee Internal Medicine - Lawrenceburg
Practice address
184 Prosser Rd
Lawrenceburg, TN 38464-4233
Phone
(931) 762-5115
NPI assigned
Oct 23, 2023
Last updated
Sep 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Authorized official

Name
Charlotte Lawrence
Title
Secretary
Phone
(615) 920-7000

Specialties & licenses 1

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

Addresses

Primary practice location

184 Prosser Rd
Lawrenceburg, TN 38464-4233

Mailing address

330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000

Other names 1

  • Southern Tennessee Internal Medicine - Lawrenceburg Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071017000313 TN Part B Supplier - Clinic/Group Practice 4789770199 Receives reassigned benefits from 92 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lawrenceburg, TN; Winchester, TN; Pulaski, TN; Mt Pleasant, TN; Loretto, TN; Decherd, TN
O20231220002107 TN Part A Provider - Rural Health Clinic 4789770199 Practice locations: Lawrenceburg, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417739640. Details of each certification follow.

Rural health clinic certification: CCN 883961

Legal name
AMG-CROCKETT, LLC
Doing business as
SOUTHERN TENNESSEE INTERNAL MEDICINE - LAWRENCEBURG
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 2, 2024
Last certification
Apr 2, 2024
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Dec 15, 1998 in DE
Enrollment address
184 Prosser Rd
Lawrenceburg, TN 38464-4233

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 20

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

View all 20

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
44D0679118Southern Tennessee Internal Medicine Lawrenceburg184 Prosser Road, Lawrenceburg, TN 38464Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Amg-Crockett LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

1605 S Locust Ave
Ste 200
Lawrenceburg, TN 38464
Phone (931) 766-4560

4955D Highway 43 N
Mt Pleasant, TN 38474
Phone (931) 964-0849

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Lifepoint Holdings 2 LLC Organization, Brentwood, TN LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Nov 1, 2023 100%
Pamela Kane Individual Corporate OfficerVice President Nov 1, 2023
DSB Acquisition LLC Organization, New York, NY LLC, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2023 100%
Laura C Hinson Individual Corporate OfficerChief Financial Officer Mar 12, 2025
Lifepoint Hospitals Holdings LLC Organization, Brentwood, TN LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2023 100%
Historic Lifepoint Hospitals, LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2023 100%
Lifepoint Health Inc Organization, Brentwood, TN Corporation, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2023 100%
Charlotte E Lawrence Individual Corporate OfficerSecretary Nov 1, 2023
Elliott Brown Individual Corporate OfficerSenior Vice President and Treasurer Apr 2, 2026
Klaus Michael Boel Individual Contracted Managing Employee Aug 19, 2024
Corporate OfficerPresident Aug 19, 2024
Christopher J Monte Individual Corporate OfficerVice President Nov 1, 2023
Legacy Lifepoint Health LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2023 100%

Facilities with the same owner 193

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

  • Amg-Crockett LLC

    dba Summertown Medical Center

    • Rural Health Clinic/Center
    • Mt Pleasant, TN
    • NPI 1255069639

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Crockett, LLC

    dba First Choice Health Lawrenceburg

    • Rural Health Clinic/Center
    • Lawrenceburg, TN
    • NPI 1023840998

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Crockett, LLC

    dba First Choice Health Loretto

    • Rural Health Clinic/Center
    • Loretto, TN
    • NPI 1811543929

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Crockett, LLC

    dba Women's Health Clinic

    • Rural Health Clinic/Center
    • Lawrenceburg, TN
    • NPI 1891580858

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Family Health - Pulaski

    • Rural Health Clinic/Center
    • Pulaski, TN
    • NPI 1063294296

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Eastside

    • Rural Health Clinic/Center
    • Pulaski, TN
    • NPI 1144052002

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Lynnville

    • Rural Health Clinic/Center
    • Lynnville, TN
    • NPI 1407688369

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Ardmore

    • Rural Health Clinic/Center
    • Ardmore, TN
    • NPI 1558117028

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Hillside LLC

    dba First Choice Health - Pulaski

    • Rural Health Clinic/Center
    • Pulaski, TN
    • NPI 1568190551

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Hillside LLC

    dba Southern Tennessee Primary Care Cornersville

    • Rural Health Clinic/Center
    • Lewisburg, TN
    • NPI 1881426740

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Southern Tennessee LLC

    dba Highpoint Family Wellness - Winchester with Ascension Saint Thomas

    • Rural Health Clinic/Center
    • Winchester, TN
    • NPI 1063140051

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
  • Amg-Southern Tennessee LLC

    dba Highpoint Family Wellness - Blackwell with Ascension Saint Thomas

    • Rural Health Clinic/Center
    • Tullahoma, TN
    • NPI 1174365803

    Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC

    CMS ownership
View all 193

Practitioners & affiliated clinicians

Practitioners 4

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": "1698019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1417739640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275098",
            "telephone_number": "615-920-7000",
            "fax_number": "615-920-8775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "184 PROSSER RD",
            "city": "LAWRENCEBURG",
            "state": "TN",
            "postal_code": "384644233",
            "telephone_number": "931-762-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG-CROCKETT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-23",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Tennessee Internal Medicine - Lawrenceburg",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southern Tennessee Internal Medicine - Lawrenceburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrenceburg, TN

Sources for this page

Verify at the official NPI Registry.