NPIMap

Organization Active NPI

WT Medical Associates

Doing business as West Tennessee Medical Group Primary Care & Women's Health

  • Rural Health Clinic/Center
  • Dyersburg, TN
National Provider Identifier
1427604198
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WT MEDICAL ASSOCIATES
Doing business as
West Tennessee Medical Group Primary Care & Women's Health
Practice address
1720 Woodlawn Ave Ste 1
Dyersburg, TN 38024-1300
Phone
(731) 287-4500
Fax
(731) 287-4804
NPI assigned
Aug 17, 2019
Last updated
Mar 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

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

Authorized official

Name
Ms. Tina Prescott
Title
President and Ceo
Phone
(731) 541-5000

Specialties & licenses 1

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

Addresses

Primary practice location

1720 Woodlawn Ave Ste 1
Dyersburg, TN 38024-1300

Mailing address

1720 Woodlawn Ave Ste 1
Dyersburg, TN 38024-1300
Phone (731) 287-4500

Other identifiers 1

IdentifierTypeStateIssuer
044-8918MedicaidTN

Other names 1

  • West Tennessee Medical Group Primary Care & Women's Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180814002772 TN Part B Supplier - Clinic/Group Practice 1951650613 Receives reassigned benefits from 107 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, TN; Martin, TN; MC Kenzie, TN; Paris, TN; Ridgely, TN; Ripley, TN; Buchanan, TN; Camden, TN…
O20191017001548 TN Part A Provider - Rural Health Clinic 1951650613 Practice locations: Dyersburg, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427604198. Details of each certification follow.

Rural health clinic certification: CCN 448918

Legal name
WT MEDICAL ASSOCIATES
Doing business as
WEST TENNESSEE MEDICAL GROUP PRIMARY CARE & WOMEN'S HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 8, 2012
Last certification
Feb 17, 2026
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
1720 Woodlawn Ave
Ste 1
Dyersburg, TN 38024-1300

Other NPIs with the same Medicare PAC ID 4

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

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

Locations

1720 Woodlawn Ave
Ste 1
Dyersburg, TN 38024
Phone (731) 285-2100

420 Wilkinson Dr
Fl 2
Dyersburg, TN 38024
Phone (731) 285-5133

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Phil Bryant Individual Corporate DirectorBoard of Trustees Member Aug 1, 2007
Jeffrey D Blankenship Individual Corporate OfficerVP Cfo Apr 17, 2019
W-2 Managing EmployeeVP Cfo Apr 17, 2019
WT Medical Associates Organization, Jackson, TN Created for acquisition, Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2019 100%
Danny Wheeler Individual Corporate DirectorBoard of Trustees Member Jun 1, 2013
Charlotte Burch Individual Corporate DirectorBoard of Trustees Member Apr 1, 2013
Tina Prescott Individual Corporate OfficerPresident and Ceo Sep 12, 2024
W-2 Managing EmployeePresident and Ceo Sep 12, 2024
Ray Washington Individual Corporate DirectorBoard of Trustees Member Aug 1, 2023
Curtis Mansfield Individual Corporate DirectorBoard of Trustees Member Apr 1, 1999

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • WT Medical Associates
    • Internal Medicine Physician
    • Dyersburg, TN
    • NPI 1295223279

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • WT Medical Associates

    dba West Tennessee Medical Group Pediatrics Paris Henry C

    • Rural Health Clinic/Center
    • Paris, TN
    • NPI 1316496029

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • WT Medical Associates

    dba West Tennessee Medical Group Primary Care Camden

    • Rural Health Clinic/Center
    • Camden, TN
    • NPI 1356021026

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • WT Medical Associates

    dba West Tennessee Medical Group Primary Care Halls

    • Rural Health Clinic/Center
    • Halls, TN
    • NPI 1356176556

    5% Or Greater Direct Ownership Interest

    CMS ownership

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
West Tennessee Medical Group Primary Care CamdenCamden, TN, CCN 883957 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2018
West Tennessee Medical Group Pediatrics Paris Henry CountyParis, TN, CCN 448976 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2024

Owned or controlled facilities with NPI records 2

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

  • WT Medical Associates

    dba West Tennessee Medical Group Pediatrics Paris Henry C

    • Rural Health Clinic/Center
    • Paris, TN
    • NPI 1316496029

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • WT Medical Associates

    dba West Tennessee Medical Group Primary Care Camden

    • Rural Health Clinic/Center
    • Camden, TN
    • NPI 1356021026

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 2

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

Change-of-ownership history 1

DateEventCounterparty
Oct 1, 2019 Change of OwnershipThis provider was the buyer Medsouth Medical Center, DyersburgCCN 448918, TN, NPI 1750688479

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1566000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743033600000",
    "number": "1427604198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 WOODLAWN AVE STE 1",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380241300",
            "telephone_number": "731-287-4500",
            "fax_number": "731-287-4804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 WOODLAWN AVE STE 1",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380241300",
            "telephone_number": "731-287-4500",
            "fax_number": "731-287-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WT MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-17",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A",
        "authorized_official_last_name": "PRESCOTT",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "731-541-5000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044-8918",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Tennessee Medical Group Primary Care & Women's Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dyersburg, TN

Sources for this page

Verify at the official NPI Registry.