NPIMap

Individual provider Active NPI

Johnny Wayne Presley, PAC

  • Medical Physician Assistant
  • Jamestown, TN
National Provider Identifier
1427069749
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA130 Issued in TN
Practice address
100 S Duncan St
Jamestown, TN 38556-3009
Phone
(931) 879-5864
Fax
(931) 879-3903
NPI assigned
Aug 11, 2006
Last updated
Sep 13, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA130 TN Primary

Addresses

Primary practice location

100 S Duncan St
Jamestown, TN 38556-3009

Mailing address

PO Box 2861
Crossville, TN 38557-2861
Phone (931) 879-5864

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091214000050 TN Practitioner - Physician Assistant 3173618766 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

18797 Alberta St
Oneida, TN 37841-2127
Phone 42356985215307

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
310TNMDAcupuncturist
PA130TNMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group, Inc. CurrentSince Jul 27, 2012 Accepting new patients
Cumberland River Medical Clinic, LLC CurrentSince Oct 26, 2023 Accepting new patients
Covenant Medical Group, Inc CurrentSince Jul 27, 2012 Accepting new patients
Emergency Coverage Services, PC Past Accepting new patients
Crossville Medical Group PA Past Accepting new patients
Primary Care of Jamestown, LLC PastSince Jan 1, 2024 Accepting new patients
Victor a. Shada, D.O., P.C. Past Accepting new patients
Scott County Community Hospital, Inc. Past Accepting new patients

Locations

102 Old Jefferson St
Celina, TN 38551
Phone (931) 243-3576

100 Lantana Rd
Ste 202
Crossville, TN 38555
Phone (931) 484-5141

4965 Peavine Rd
Crossville, TN 38571
Phone (931) 484-5141

Dept 888179
Knoxville, TN 37995

111 Clyde St
Loudon, TN 37774
Phone (865) 458-1554

18797 Alberta St
Oneida, TN 37841
Phone (423) 286-5300

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Pikeville Urgent Care PLLCPikeville, TN, CCN 448960 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%)
Corporate Officer (100%)
W-2 Managing Employee (100%)
Operational/Managerial Control (100%)		 Jan 1, 2024
Jan 1, 2024
Jan 1, 2024
Jan 1, 2024
Monterey Medical LLCMonterey, TN, CCN 883857 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%)
Corporate Officer (100%)
W-2 Managing Employee (100%)
Operational/Managerial Control (100%)		 Dec 12, 2022
Dec 12, 2022
Dec 12, 2022
Dec 12, 2022
Primary Care of Jamestown LLCJamestown, TN, CCN 888925 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%)
Corporate Officer (100%)
W-2 Managing Employee (100%)		 Feb 2, 2023
Feb 2, 2023
Feb 2, 2023

Owned or controlled facilities with NPI records 3

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

  • Monterey Medical LLC
    • Rural Health Clinic/Center
    • Monterey, TN
    • NPI 1497339790

    5% Or Greater Indirect Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership
  • Pikeville Urgent Care, PLLC
    • Rural Health Clinic/Center
    • Pikeville, TN
    • NPI 1316321953

    5% Or Greater Indirect Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership
  • Primary Care of Jamestown, LLC
    • Rural Health Clinic/Center
    • Jamestown, TN
    • NPI 1215717772

    5% Or Greater Indirect Ownership Interest, Corporate Officer, W-2 Managing Employee

    CMS ownership

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1427069749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2861",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385572861",
            "telephone_number": "931-879-5864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S DUNCAN ST",
            "city": "JAMESTOWN",
            "state": "TN",
            "postal_code": "385563009",
            "telephone_number": "931-879-5864",
            "fax_number": "931-879-3903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESLEY",
        "first_name": "JOHNNY",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "PA130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamestown, TN

Sources for this page

Verify at the official NPI Registry.