NPIMap

Organization Active NPI

Maury Regional Hospital

Doing business as Primary Care Federally Qualified Health Center - Waynesboro

  • Federally Qualified Health Center (FQHC)
  • Waynesboro, TN
National Provider Identifier
1669983995
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MAURY REGIONAL HOSPITAL
Doing business as
Primary Care Federally Qualified Health Center - Waynesboro
Practice address
321 Dexter L Woods Memorial Blvd Ste E
Waynesboro, TN 38485-2418
Phone
(931) 722-9999
Fax
(931) 722-2049
NPI assigned
Oct 13, 2017
Last updated
Aug 8, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MAURY REGIONAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Authorized official

Name
Charles J Brinkley III
Title
Cfo
Phone
(931) 540-4212

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

321 Dexter L Woods Memorial Blvd Ste E
Waynesboro, TN 38485-2418

Mailing address

PO Box 100054
Atlanta, GA 30348-0054
Phone (931) 796-4901

Other names 1

  • Primary Care Federally Qualified Health Center - Waynesboro Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040330001709 TN Part B Supplier - Clinic/Group Practice 4688569718 Receives reassigned benefits from 54 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lewisburg, TN; Waynesboro, TN; Spring Hill, TN; Hohenwald, TN; Ethridge, TN; Columbia, TN; Collinwood, TN
O20180103002487 TN Part A Provider - Federally Qualified Health Center (FQHC) 4688569718 Practice locations: Waynesboro, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669983995. Details of each certification follow.

Federally qualified health center certification: CCN 441983

Legal name
MAURY REGIONAL HOSPITAL
Doing business as
PRIMARY CARE FEDERALLY QUALIFIED HEALTH CENTER- WAYNESBORO
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 5, 2018
Last certification
Apr 5, 2018
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
321 Dexter L Woods Memorial Blvd
Ste E
Waynesboro, TN 38485-2418

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 5

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

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
44D0882921Maury Regional Hospital Dba Primary Care321 Dexter L Woods Blvd, Suite E, Waynesboro, TN 38485Certificate of waiverFeb 18, 2028

National Provider Directory

National Provider Directory
Tax ID family
Maury Reg Hospital16 organizations share this tax ID, including this one
Part of
Maury Reg Hospital

Other organizations with this tax ID 15

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

View all 15

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
Richard D Schefke Individual Operational/Managerial ControlAssociate Chief Financial Officer Mar 25, 2025
Maury County Government Organization, Columbia, TN Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Sep 14, 2017 100%
Gregory Whitlock Individual Corporate DirectorVP Finance & It Apr 2, 2018
W-2 Managing EmployeeVP Finance & It Apr 2, 2018

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
NHC-Maury Regional Transitional Care CenterColumbia, TN, CCN 445030 Skilled nursing facility 5% Or Greater Direct Ownership Interest (20%)
Operational/Managerial Control		 Jan 1, 2017
Jan 1, 2017
Maury Regional Urgent Care NorthColumbia, TN, CCN 443465 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 26, 2020
Maury Regional Urgent Care ColumbiaColumbia, TN, CCN 443466 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 26, 2020
MRMG Mt PleasantMt Pleasant, TN, CCN 443467 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 26, 2020
MRMG Spring HillSpring Hill, TN, CCN 443468 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 26, 2020

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1507852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723075200000",
    "number": "1669983995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100054",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303480054",
            "telephone_number": "931-796-4901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 DEXTER L WOODS MEMORIAL BLVD STE E",
            "city": "WAYNESBORO",
            "state": "TN",
            "postal_code": "384852418",
            "telephone_number": "931-722-9999",
            "fax_number": "931-722-2049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAURY REGIONAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAURY REGIONAL HOSPITAL",
        "enumeration_date": "2017-10-13",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A",
        "authorized_official_last_name": "BRINKLEY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "931-540-4212",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Care Federally Qualified Health Center - Waynesboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waynesboro, TN

Sources for this page

Verify at the official NPI Registry.