NPIMap

Organization Active NPI

Upper Cumberland Rural Health Clinic PLLC

Doing business as TN Pediatric and Adolescent Center

  • Rural Health Clinic/Center
  • Cookeville, TN
National Provider Identifier
1679378079
Registry record updated Feb 18, 2025
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
Doing business as
TN Pediatric and Adolescent Center
Practice address
435 N Cedar Ave
Cookeville, TN 38501-2422
Phone
(931) 526-6100
NPI assigned
Feb 18, 2025
Last updated
Feb 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

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 NU Primary

Addresses

Primary practice location

435 N Cedar Ave
Cookeville, TN 38501-2422

Mailing address

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

Other names 1

  • TN PEDIATRIC AND ADOLESCENT CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250512000869 TN Part A Provider - Rural Health Clinic 8820198138 Practice locations: Cookeville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679378079. Details of each certification follow.

Rural health clinic certification: CCN 888937

Legal name
UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC
Doing business as
TN PEDIATRIC & ADOLESCENT CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 3, 2025
Last certification
Jun 3, 2025
Ownership / control type
1A
Organization structure
LLCProprietary
Enrollment address
435 N Cedar Ave
Cookeville, TN 38501-2422

Other NPIs with the same Medicare PAC ID 8

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

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

435 N Cedar Ave
Cookeville, TN 38501
Phone (931) 526-6100

402 E Gore Ave
Gainesboro, TN 38562
Phone (931) 268-0221

165 Shelton St
Sparta, TN 38583
Phone (931) 738-9316

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 Mar 1, 2025 100%
Corporate OfficerPresident Mar 1, 2025 100%
W-2 Managing EmployeePresident Mar 1, 2025 100%
Operational/Managerial ControlPresident Mar 1, 2025 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 1

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": "1739836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739836800000",
    "number": "1679378079",
    "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": "435 N CEDAR AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012422",
            "telephone_number": "931-526-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-18",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TN PEDIATRIC AND ADOLESCENT CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.