NPIMap

Organization Active NPI

WT Regional Medical Associates

Doing business as West Tennessee Medical Group Primary Care Caruthersville

  • Rural Health Clinic/Center
  • Caruthersville, MO
National Provider Identifier
1477870467
Registry record updated Oct 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WT REGIONAL MEDICAL ASSOCIATES
Doing business as
West Tennessee Medical Group Primary Care Caruthersville
Practice address
108 W 15TH Street
Caruthersville, MO 63830-2202
Phone
(731) 512-1277
NPI assigned
Apr 29, 2010
Last updated
Oct 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2025

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

Authorized official

Name
James E Ross, PRESIDENT
Title
Ceo
Phone
(731) 541-6735

Specialties & licenses 1

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

Addresses

Primary practice location

108 W 15TH Street
Caruthersville, MO 63830-2202

Mailing address

108 W 15TH St
Caruthersville, MO 63830-2202
Phone (573) 333-0033

Other identifiers 1

IdentifierTypeStateIssuer
079-3800MedicaidMO

Other names 1

  • West Tennessee Medical Group Primary Care Caruthersville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180822000052 MO Part A Provider - Rural Health Clinic 5698024891 Practice locations: Caruthersville, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477870467. Details of each certification follow.

Rural health clinic certification: CCN 793800

Legal name
WT REGIONAL MEDICAL ASSOCIATES
Doing business as
WEST TENNESSEE MEDICAL GROUP PRIMARY CARE CARUTHERSVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 8, 2010
Last certification
Oct 23, 2023
Ownership / control type
2B
Most recent change of ownership
Jun 1, 2018 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
108 W 15TH St
Caruthersville, MO 63830-2202

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
26D1001809West Tennessee Medical Group Primary Care108 West 15TH Street, Caruthersville, MO 63830Certificate of waiverJul 21, 2028

National Provider Directory

National Provider Directory

Locations

900 Washington Ave
Caruthersville, MO 63830
Phone (573) 922-8096

108 W 15th St
Caruthersvlle, MO 63830
Phone (573) 333-0033

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Jeffrey D Blankenship Individual Corporate OfficerVP & Cfo Apr 12, 2018
W-2 Managing EmployeeVP & Cfo Apr 12, 2018
Jackson Madison County General Hospital Organization, Caruthersville, MO Non-profit Operational/Managerial Control Jun 1, 2018
WT Regional Medical Associates Organization, Caruthersville, MO Created for acquisition, Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 2018 100%
Tina Prescott Individual Corporate OfficerPresident and Ceo Sep 12, 2024
W-2 Managing EmployeePresident and Ceo Sep 12, 2024

Owners & managing parties with NPI records 8

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

Facilities with the same owner 12

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

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": "1272499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761782400000",
    "number": "1477870467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 W 15TH ST",
            "city": "CARUTHERSVILLE",
            "state": "MO",
            "postal_code": "638302202",
            "telephone_number": "573-333-0033",
            "fax_number": "573-333-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 W 15TH STREET",
            "city": "CARUTHERSVILLE",
            "state": "MO",
            "postal_code": "638302202",
            "telephone_number": "731-512-1277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WT REGIONAL MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-29",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "731-541-6735",
        "authorized_official_credential": "PRESIDENT"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "079-3800",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Tennessee Medical Group Primary Care Caruthersville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Caruthersville, MO

Sources for this page

Verify at the official NPI Registry.