NPIMap

Organization Active NPI

Clarksville Health System, LLC

  • Rehabilitation Hospital Unit
  • Clarksville, TN
National Provider Identifier
1659326700
Registry record updated Mar 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
000000090 Issued in TN
Legal business name
CLARKSVILLE HEALTH SYSTEM, LLC
Practice address
651 Dunlop LN
Clarksville, TN 37040-5015
Phone
(931) 502-1000
Fax
(931) 502-1215
NPI assigned
May 24, 2006
Organization subpart
Yes
Parent organization
CLARKSVILLE HEALTH SYSTEM, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 10, 2026

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

Authorized official

Name
Cecelia B. Moore
Title
Authorized Official/Treasurer
Phone
(615) 322-0084

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 000000090 TN Primary

Addresses

Primary practice location

651 Dunlop LN
Clarksville, TN 37040-5015

Mailing address

3841 Green Hills Village Dr Ste 200
Nashville, TN 37215-2691

Other identifiers 1

IdentifierTypeStateIssuer
1000156MedicaidTN

Other names 2

  • Tennova Healthcare-Clarksville Doing business as
  • Vanderbilt Clarksville Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070224000043 TN Part A Provider - Hospital 6305856600 Practice locations: Clarksville, TN

Hospital certification: CCN 44T035

Legal name
CLARKSVILLE HEALTH SYSTEM, LLC
Doing business as
VANDERBILT CLARKSVILLE HOSPITAL
Organization structure
LLC
Incorporated
Sep 19, 2005 in DE
Enrollment address
651 Dunlop LN
Clarksville, TN 37040-5015
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Tennova Healthare - ClarksvilleCCN 44T035
Ownership
For profit
Certified
Jan 1, 2009

National Provider Directory

National Provider Directory
Part of
Clarksville Health System LLC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

651 Dunlop Ln
#4100
Clarksville, TN 37040

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
John R Ingram Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Cecelia Moore Individual Corporate OfficerTreasurer Feb 1, 2026
Gail Carr Williams Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Vanderbilt Montgomery Holdings LLC Organization, Nashville, TN LLC 5% Or Greater Direct Ownership Interest Dec 31, 2020 100%
John Frederick Stein Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Angela Simmons Individual W-2 Managing EmployeeVice President - Finance Feb 1, 2026
Daniel Diermeier Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Bruce Evans Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Edith Carell Johnson Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Makeba Williams Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Jane Freedman Individual Corporate OfficerPresident Feb 1, 2026
Colin Reed Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Vanderbilt University Medical Center Organization, Nashville, TN Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Dec 31, 2020 100%
Lucinda M Baier Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Sara Finley Individual Corporate DirectorGoverning Board Member Feb 1, 2026
William F. Carpenter Individual Corporate DirectorGoverning Board Member Feb 1, 2026
Randall Davis Individual Corporate OfficerPresident Vanderbilt Clarksville Feb 1, 2026
Raymond D Mefford Individual Corporate OfficerSecretary/General Counsel Feb 1, 2026

Owners & managing parties with NPI records 13

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

View all 13

Facilities with the same owner 19

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

View all 19

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773100800000",
    "number": "1659326700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 GREEN HILLS VILLAGE DR STE 200",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372152691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 DUNLOP LN",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370405015",
            "telephone_number": "931-502-1000",
            "fax_number": "931-502-1215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSVILLE HEALTH SYSTEM, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLARKSVILLE HEALTH SYSTEM, LLC",
        "enumeration_date": "2006-05-24",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "CECELIA",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL/TREASURER",
        "authorized_official_telephone_number": "615-322-0084"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "TN",
            "license": "000000090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000156",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Tennova Healthcare-Clarksville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vanderbilt Clarksville Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksville, TN

Sources for this page

Verify at the official NPI Registry.