NPIMap

Organization Active NPI

Tennessee Primary Care, LLC

  • Rural Health Clinic/Center
  • Cookeville, TN
National Provider Identifier
1669367322
Registry record updated Jun 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TENNESSEE PRIMARY CARE, LLC
Practice address
768 S Willow Ave Ste a
Cookeville, TN 38501-3892
Phone
(931) 559-6900
Fax
(931) 548-6909
NPI assigned
Jun 11, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2025

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

Authorized official

Name
Michael David PattersonNPI 1851654867
Title
Member
Phone
(931) 456-2728

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

768 S Willow Ave Ste a
Cookeville, TN 38501-3892

Mailing address

768 S Willow Ave
Cookeville, TN 38501-3892
Phone (931) 559-6900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250711001092 TN Part A Provider - Rural Health Clinic 3870939051 Practice locations: Cookeville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669367322. Details of each certification follow.

Rural health clinic certification: CCN 888944

Legal name
TENNESSEE PRIMARY CARE, LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 19, 2025
Last certification
Nov 19, 2025
Ownership / control type
1C
Organization structure
LLCProprietary
Enrollment address
768 S Willow Ave
Ste a
Cookeville, TN 38501-3892

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Michael David Patterson Individual 5% Or Greater Direct Ownership InterestOwner Nov 30, 2023 50%
Operational/Managerial ControlOwner Jun 1, 2025 50%
Sonya Lane Individual W-2 Managing EmployeeOffice Manager Jun 1, 2025 100%
Andrew David Johnson Individual 5% Or Greater Direct Ownership InterestOwner Nov 30, 2023 50%
Operational/Managerial ControlOwner Jun 1, 2025 50%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1749600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749600000000",
    "number": "1669367322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "768 S WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385013892",
            "telephone_number": "931-559-6900",
            "fax_number": "931-548-6909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "768 S WILLOW AVE STE A",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385013892",
            "telephone_number": "931-559-6900",
            "fax_number": "931-548-6909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-11",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "931-456-2728"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.