Advanced Family Medical Center

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

ADVANCED FAMILY MEDICAL CENTER

Practice address

101 Main St N
Middleton, TN 38052-3433

Phone

(731) 472-2147

Fax

(731) 472-2148

NPI assigned

Mar 26, 2018

Last updated

Feb 8, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

William V Caicedo, FNPNPI 1851732259

Title

NP

Phone

(731) 518-7391

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467957126. Details of each certification follow.

• CCN 883807 Rural health clinic · Active · Details

Rural health clinic certification: CCN 883807

Legal name

ADVANCED FAMILY MEDICAL CENTER

Doing business as

ADVANCED FAMILY MEDICAL CENTER

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Nov 12, 2019

Last certification

Nov 12, 2019

Ownership / control type

1B

Organization structure

LLCProprietary

Incorporated

Mar 26, 2018 in TN

Enrollment address

101 Main St N
Middleton, TN 38052-3433

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 1

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

Owners & managing parties with NPI records 1

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

• William Vidal Caicedo, FNP-C

  • Family Nurse Practitioner
  • Middleton, TN
  • NPI 1851732259

  5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

  CMS ownership

Practitioners 1

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.

• William Vidal Caicedo, FNP-C

  • Family Nurse Practitioner
  • Middleton, TN
  • NPI 1851732259
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549584000000",
    "number": "1467957126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MAIN ST N",
            "city": "MIDDLETON",
            "state": "TN",
            "postal_code": "380523433",
            "telephone_number": "731-472-2147",
            "fax_number": "731-472-2148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MAIN ST N",
            "city": "MIDDLETON",
            "state": "TN",
            "postal_code": "380523433",
            "telephone_number": "731-472-2147",
            "fax_number": "731-472-2148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-26",
        "last_updated": "2019-02-08",
        "status": "A",
        "authorized_official_last_name": "CAICEDO",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "731-518-7391",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "17787",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q001019",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anew Family Medical PLLC
• William Vidal Caicedo, FNP-C
• Teresa Morgan Dillinger, FNP
• Tonya Freeman, FNP-C
• Innovative Health Medical Clinic Inc.

• Rural Health Clinic/Center in Middleton, TN
• Providers in Middleton, TN by specialty
• Rural Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.