Organization Active NPI

Healthy Life Family Medicine LLPC

  • Family Medicine Physician
  • Winchester, TN
National Provider Identifier
1679928485
Registry record updated Jul 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2308 Issued in TN
Legal business name
HEALTHY LIFE FAMILY MEDICINE LLPC
Practice address
1383 S College St
Ste. 2
Winchester, TN 37398-2414
Phone
(931) 810-8012
Fax
(931) 241-6630
NPI assigned
Apr 29, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2016

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

Authorized official

Name
Sherri L. Walker, DONPI 1265586259
Title
Owner
Phone
(814) 860-1710

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 2308 TN Primary

Addresses

Primary practice location

1383 S College St
Ste. 2
Winchester, TN 37398-2414

Mailing address

1383 S College St
Ste. 2
Winchester, TN 37398-2414
Phone (931) 810-8012

Other identifiers 1

IdentifierTypeStateIssuer
Q021424MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160627001358 TN Part B Supplier - Clinic/Group Practice 4385935196 Receives reassigned benefits from 1 practitioner
Practice locations: Winchester, TN

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
44D2112046Healthy-Life Medicine LLPC1383 S College Street, Suite 2, Winchester, TN 37398Certificate of waiverApr 20, 2028

National Provider Directory

National Provider Directory

Locations

1383 S College St
Ste 2
Winchester, TN 37398
Phone (706) 952-1303

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25271/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

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": "1461888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467763200000",
    "number": "1679928485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1383 S COLLEGE ST",
            "address_2": "STE. 2",
            "city": "WINCHESTER",
            "state": "TN",
            "postal_code": "373982414",
            "telephone_number": "931-810-8012",
            "fax_number": "931-241-6630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1383 S COLLEGE ST",
            "address_2": "STE. 2",
            "city": "WINCHESTER",
            "state": "TN",
            "postal_code": "373982414",
            "telephone_number": "931-810-8012",
            "fax_number": "931-241-6630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY LIFE FAMILY MEDICINE LLPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-29",
        "last_updated": "2016-07-06",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "SHERRI",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-860-1710",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "2308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q021424",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winchester, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.