NPIMap

Organization Active NPI

Coffee Medical Group LLC

Doing business as Center for Family Medicine

  • Rural Health Clinic/Center
  • Manchester, TN
National Provider Identifier
1700192028
Registry record updated Feb 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
19 Issued in TN
Legal business name
COFFEE MEDICAL GROUP LLC
Doing business as
Center for Family Medicine
Practice address
1615 McMinnville Hwy
Manchester, TN 37355-3179
Phone
(931) 728-6205
Fax
(931) 723-3194
NPI assigned
Aug 24, 2010
Last updated
Feb 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2024

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

Authorized official

Name
Mr. Robert J Couch
Title
Ceo
Phone
(931) 728-6354

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 19 TN Primary

Addresses

Primary practice location

1615 McMinnville Hwy
Manchester, TN 37355-3179

Mailing address

1615 McMinnville Hwy
Manchester, TN 37355-3179
Phone (931) 728-6205

Other names 1

  • CENTER FOR FAMILY MEDICINE Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120322000701 TN Part B Supplier - Clinic/Group Practice 1456317783 Receives reassigned benefits from 3 practitioners
2 other NPIs on this enrollment
Practice locations: Manchester, TN
O20160125000433 TN Part A Provider - Rural Health Clinic 1850208794 Practice locations: Manchester, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700192028. Details of each certification follow.

Rural health clinic certification: CCN 443450

Legal name
COFFEE MEDICAL GROUP LLC
Doing business as
CENTER FOR FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 2015
Last certification
Nov 1, 2016
Ownership / control type
1B
Organization structure
LLCNon-profit
Incorporated
Jun 7, 2002 in TN
Enrollment address
1615 McMinnville Hwy
Manchester, TN 37355-3179
Related CCNs
440007

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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
44D0309672Coffee Medical Group LLC1615 McMinnville Hwy, Manchester, TN 37355Certificate of waiverJan 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Coffee Medical Group LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Unity Medical Center Inc Organization, Manchester, TN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 15, 2019 100%
Martha McCormick Individual Corporate OfficerCeo Jan 1, 2013 35%
Amy Freeze Individual W-2 Managing EmployeeClinic Manager Jul 1, 2015 10%
Doug McAbee Individual Corporate OfficerCfo Feb 1, 2024 5%
Medical Associates Development LLC Organization, Manchester, TN LLC 5% Or Greater Security Interest Jul 1, 2015 32%
Servisfirst Bank Organization, Nashville, TN Corporation, Financial institution, For-profit 5% Or Greater Security Interest Jul 15, 2019 56%

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 89

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 89

NPI Registry JSON

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

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707436800000",
    "number": "1700192028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 MCMINNVILLE HWY",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373553179",
            "telephone_number": "931-728-6205",
            "fax_number": "931-723-3194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 MCMINNVILLE HWY",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373553179",
            "telephone_number": "931-728-6205",
            "fax_number": "931-723-3194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-24",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A",
        "authorized_official_last_name": "COUCH",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "931-728-6354",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TN",
            "license": "19",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CENTER FOR FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manchester, TN

Sources for this page

Verify at the official NPI Registry.