P a Corporate Enterprises LLP

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

P A CORPORATE ENTERPRISES LLP

Doing business as

South Gibson Family Care

Practice address

589 Highway 45 Byp S
Medina, TN 38355-9633

Phone

(713) 462-0000

NPI assigned

Jan 6, 2017

Last updated

Jun 21, 2021By 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

David Jeff Wilbert, PA-C

Title

Owner

Phone

(713) 462-0000

Specialties & licenses 2

Addresses

Other names 1

• South Gibson Family Care Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• PA Corporate Enterprises, LLP

  dba greenfield family care

  • Rural Health Clinic/Center
  • Greenfield, TN
  • NPI 1518226646

  O20120718000320

  Same enrollment

Locations

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.

• Michael Allen Revelle, M.D.

  • Emergency Medicine Physician
  • Jackson, TN
  • NPI 1295714558
  NPD
• Marion Joy Scott, FNP

  • Nurse Practitioner
  • Medina, TN
  • NPI 1952494643
  NPD

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

{
    "created_epoch": "1483660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1598201196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "589 HIGHWAY 45 BYP S",
            "city": "MEDINA",
            "state": "TN",
            "postal_code": "383559633",
            "telephone_number": "713-462-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "589 HIGHWAY 45 BYP S",
            "city": "MEDINA",
            "state": "TN",
            "postal_code": "383559633",
            "telephone_number": "713-462-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P A CORPORATE ENTERPRISES LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-06",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "WILBERT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JEFF",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "713-462-0000",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Gibson Family Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Gibson Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Medina Family Medical Clinic PC
• Medina Health & Rehabilitation LLC
• Kimberle Anne Moody, PTA
• Rachel Alexandra Nelson, DO
• Michael Edward Ort, M.D.
• Luis Pagoaga, M.D.
• Molly Beth Paterson
• Patterson Family Dentistry
• Brian S Patterson, D.D.S., B.S.
• Darren R Perry, CFNP

• Multi-Specialty Clinic/Center in Medina, TN
• Providers in Medina, TN by specialty
• Multi-Specialty Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.