NPIMap

Organization Active NPI

Upper Cumberland Rural Health Clinic PLLC

  • Rural Health Clinic/Center
  • Cookeville, TN
National Provider Identifier
1619720406
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC
Practice address
2546 Windle Community Rd
Cookeville, TN 38506-7941
Phone
(931) 498-4880
NPI assigned
Apr 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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

Authorized official

Name
Dr. Pushpendra K Jain, MDNPI 1689748634
Title
Owner
Phone
(931) 528-8899

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 1

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

Addresses

Primary practice location

2546 Windle Community Rd
Cookeville, TN 38506-7941

Mailing address

225 N Willow Ave Ste 3
Cookeville, TN 38501-2453

Other names 1

  • Rickman Medical Clinic RHC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241218000056 TN Part A Provider - Rural Health Clinic 8820198138 Practice locations: Cookeville, TN

Rural health clinic certification: CCN 888924

Legal name
UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC
Doing business as
RICKMAN MEDICAL CLINIC RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 31, 2025
Last certification
Jan 31, 2025
Ownership / control type
1A
Organization structure
LLCProprietary
Enrollment address
2546 Windle Community Rd
Cookeville, TN 38506-7941

Other NPIs with the same Medicare PAC ID 8

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
44D2314362Rickman Medical Clinic2546 Windle Community Rd, Cookeville, TN 38506Certificate of waiverNov 18, 2026

National Provider Directory

National Provider Directory
Tax ID family
Baxter Medical Clinic RHC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

4 Courthouse Sq
Byrdstown, TN 38549
Phone (931) 864-0222

2546 Windle Community Rd
Cookeville, TN 38506
Phone (931) 498-4880

Ownership & related parties

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.

NameRoleSinceShare
Pushpendra K Jain Individual 5% Or Greater Direct Ownership InterestPresident Jul 1, 2023 100%
Corporate OfficerPresident Jul 1, 2023 100%
W-2 Managing EmployeePresident Jul 1, 2023 100%
Operational/Managerial ControlPresident Jul 1, 2023 100%

Owners & managing parties with NPI records 1

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

  • Pushpendra K Jain, MD
    • Family Medicine Physician
    • Cookeville, TN
    • NPI 1689748634

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

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1712707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734048000000",
    "number": "1619720406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 N WILLOW AVE STE 3",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2546 WINDLE COMMUNITY RD",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385067941",
            "telephone_number": "931-498-4880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-10",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A",
        "authorized_official_last_name": "JAIN",
        "authorized_official_first_name": "PUSHPENDRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-528-8899",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rickman Medical Clinic RHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.