NPIMap

Organization Active NPI

Chelsey Sparks Dba Decaturville Family Practice

  • Rural Health Clinic/Center
  • Decaturville, TN
National Provider Identifier
1730610452
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CHELSEY SPARKS DBA DECATURVILLE FAMILY PRACTICE
Practice address
187 W Main St
Decaturville, TN 38329-8078
Phone
(731) 852-2761
NPI assigned
Mar 23, 2017
Last updated
Jun 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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

Authorized official

Name
Chelsey Johnson SparksNPI 1295008795
Title
FNP
Phone
(731) 852-2761

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

187 W Main St
Decaturville, TN 38329-8078

Mailing address

187 W Main St
Decaturville, TN 38329-8078
Phone (731) 852-2761

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL cjsparks09@live.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170629002334 TN Part B Supplier - Clinic/Group Practice 3971872284 Receives reassigned benefits from 5 practitioners
Practice locations: Decaturville, TN

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

Locations

187 W Main St
Decaturville, TN 38329
Phone (731) 852-2761

Practitioners & affiliated clinicians

Practitioners 7

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": "1490227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655856000000",
    "number": "1730610452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "187 W MAIN ST",
            "city": "DECATURVILLE",
            "state": "TN",
            "postal_code": "383298078",
            "telephone_number": "731-852-2761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 W MAIN ST",
            "city": "DECATURVILLE",
            "state": "TN",
            "postal_code": "383298078",
            "telephone_number": "731-852-2761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHELSEY SPARKS DBA DECATURVILLE FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-23",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A",
        "authorized_official_last_name": "SPARKS",
        "authorized_official_first_name": "CHELSEY",
        "authorized_official_middle_name": "JOHNSON",
        "authorized_official_title_or_position": "FNP",
        "authorized_official_telephone_number": "731-852-2761"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "cjsparks09@live.com",
            "affiliation": "N",
            "endpointDescription": "jbjohnson@tds.net",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "cjsparks09@live.com",
            "address_1": "187 W Main St",
            "city": "Decaturville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "383298078",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Decaturville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.