NPIMap

Organization Active NPI

Medina Family Medical Clinic PC

  • Rural Health Clinic/Center
  • Medina, TN
National Provider Identifier
1609881150
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
MEDINA FAMILY MEDICAL CLINIC PC
Practice address
209 Grace CV
Medina, TN 38355-8785
Phone
(731) 783-0400
Fax
(731) 783-0402
NPI assigned
Jul 30, 2006
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
Mechelle T Perry, CFNPNPI 1225150667
Title
Owner
Phone
(731) 783-0400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU

Addresses

Primary practice location

209 Grace CV
Medina, TN 38355-8785

Mailing address

PO Box 100
Medina, TN 38355-0100
Phone (731) 783-0400

Other identifiers 1

IdentifierTypeStateIssuer
3727175MedicaidTN

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041103000627 TN Part B Supplier - Clinic/Group Practice 9931161726 Receives reassigned benefits from 8 practitioners
Practice locations: Medina, TN
O20180321002861 TN Part A Provider - Rural Health Clinic 9931161726 Practice locations: Medina, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609881150. Details of each certification follow.

Rural health clinic certification: CCN 448996

Legal name
MEDINA FAMILY MEDICAL CLINIC, PC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 24, 2018
Last certification
May 30, 2024
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jul 8, 2004 in TN
Enrollment address
209 Grace CV
Medina, TN 38355-8785

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
44D1029832Medina Family Medical Clinic, PC209 Grace Cove, Medina, TN 38355Certificate of waiverNov 29, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Mechelle T Perry Individual 5% Or Greater Direct Ownership InterestSecretary Jul 8, 2004 50%
Corporate OfficerSecretary Jul 8, 2004 50%
W-2 Managing EmployeeSecretary Jul 8, 2004 50%
Operational/Managerial ControlSecretary Jul 8, 2004 50%
Darren R Perry Individual 5% Or Greater Direct Ownership InterestPresident Jul 8, 2004 50%
Corporate OfficerPresident Jul 8, 2004 50%
W-2 Managing EmployeePresident Jul 8, 2004 50%
Operational/Managerial ControlPresident Jul 8, 2004 50%

Owners & managing parties with NPI records 2

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

  • Darren R Perry, CFNP
    • Nurse Practitioner
    • Medina, TN
    • NPI 1417982315

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership
  • Mechelle T Perry, CFNP
    • Nurse Practitioner
    • Medina, TN
    • NPI 1225150667

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 8

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": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761782400000",
    "number": "1609881150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "MEDINA",
            "state": "TN",
            "postal_code": "383550100",
            "telephone_number": "731-783-0400",
            "fax_number": "731-783-0402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 GRACE CV",
            "city": "MEDINA",
            "state": "TN",
            "postal_code": "383558785",
            "telephone_number": "731-783-0400",
            "fax_number": "731-783-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDINA FAMILY MEDICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "MECHELLE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-783-0400",
        "authorized_official_credential": "CFNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3727175",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medina, TN

Sources for this page

Verify at the official NPI Registry.