NPIMap

Organization Active NPI

Access Medical Clinic LLC

  • Rural Health Clinic/Center
  • Crossville, TN
National Provider Identifier
1548017601
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ACCESS MEDICAL CLINIC LLC
Practice address
40 Elmo Dr
Crossville, TN 38555-4807
Phone
(931) 484-5525
NPI assigned
May 6, 2024
Last updated
Dec 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Authorized official

Name
Monya York
Title
Controller
Phone
(870) 856-1202

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

40 Elmo Dr
Crossville, TN 38555-4807

Mailing address

4196 Highway 62 412 Ste a
Hardy, AR 72542-8002
Phone (870) 856-1202

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240820001557 TN Part A Provider - Rural Health Clinic 1951721802 Practice locations: Crossville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548017601. Details of each certification follow.

Rural health clinic certification: CCN 888917

Legal name
ACCESS MEDICAL CLINIC LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 4, 2024
Last certification
Dec 4, 2024
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Sep 22, 2022 in TN
Enrollment address
40 Elmo Dr
Crossville, TN 38555-4807

Other NPIs with the same Medicare PAC ID 10

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

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
44D2305780Access Medical Clinic LLC40 Elmo Drive, Crossville, TN 38555Certificate of waiverJun 5, 2028

National Provider Directory

National Provider Directory
Tax ID family
Access Medical Clinic11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

204 Glades Rd
Gatlinburg, TN 37738
Phone (865) 436-2811

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Howard Freeman Individual Corporate DirectorSVP of Clinic Division May 19, 2026
W-2 Managing EmployeeAd; May 19, 2026
Operational/Managerial ControlSVP of Clinic Division May 19, 2026
Mark Hahn Individual 5% Or Greater Direct Ownership InterestDO May 8, 2025
Corporate OfficerMedical Director May 8, 2025
Tony D James Individual Corporate OfficerCfo May 19, 2026
W-2 Managing EmployeeAd; May 19, 2026
Jared Clifford Individual Corporate OfficerCeo May 8, 2025
W-2 Managing EmployeeAd; May 19, 2026
Monya York Individual Corporate DirectorDirector Credentialing May 8, 2025
W-2 Managing EmployeeDirector Credentialing May 8, 2025
Operational/Managerial ControlDirector Credentialing May 8, 2025
Randi L Davis Individual Corporate DirectorSr Director Clinic Operation May 19, 2026
W-2 Managing EmployeeAd; May 8, 2025
Operational/Managerial ControlSr Director Clinic Operation May 19, 2026
Kasey Crawford Individual Corporate DirectorDirector Clinic Operation May 19, 2025
W-2 Managing EmployeeAd; May 19, 2026
Operational/Managerial ControlDirector Clinic Operation May 19, 2026

Owners & managing parties with NPI records 2

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

  • Randi L Davis, APRN
    • Family Nurse Practitioner
    • Bay, AR
    • NPI 1740622497

    Corporate Director, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership
  • Mark S Hahn, DO
    • Family Medicine Physician
    • Caraway, AR
    • NPI 1609895911

    5% Or Greater Direct Ownership Interest, Corporate Officer

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 2

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": "1714953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1548017601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4196 HIGHWAY 62 412 STE A",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725428002",
            "telephone_number": "870-856-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 ELMO DR",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554807",
            "telephone_number": "931-484-5525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-06",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "MONYA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "870-856-1202"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crossville, TN

Sources for this page

Verify at the official NPI Registry.