NPIMap

Organization Active NPI

Ocoee Regional Health Corporation

Doing business as Meigs County Primary Care Center

  • Federally Qualified Health Center (FQHC)
  • Decatur, TN
National Provider Identifier
1760694665
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OCOEE REGIONAL HEALTH CORPORATION
Doing business as
Meigs County Primary Care Center
Practice address
305 River Rd
Decatur, TN 37322-7801
Phone
(423) 334-4154
Fax
(423) 334-4195
NPI assigned
May 4, 2007
Last updated
Jun 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Authorized official

Name
Mr. Bill R Moats
Title
Ceo
Phone
(423) 338-8995

Specialties & licenses 1

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

Addresses

Primary practice location

305 River Rd
Decatur, TN 37322-7801

Mailing address

PO Box 589
Decatur, TN 37322-0589
Phone (423) 334-4154

Other names 1

  • Meigs County Primary Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040831000520 TN Part A Provider - Federally Qualified Health Center (FQHC) 1355233693 Practice locations: Decatur, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760694665. Details of each certification follow.

Federally qualified health center certification: CCN 441818

Legal name
OCOEE REGIONAL HEALTH CORPORATION
Doing business as
MEIGS COUNTY PRIMARY CARE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 1, 1993
Last certification
Feb 1, 1993
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 1978 in TN
Enrollment address
305 River Rd
Decatur, TN 37322-7801

Other NPIs with the same Medicare PAC ID 11

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

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
44D0904149Meigs County Primary Care Center305 River Road, Decatur, TN 37322ComplianceSep 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ocoee Regional Health C14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Kimberly Bishop Individual Corporate Director Aug 12, 2010
William Moats Individual Corporate DirectorPresident/Ceo Aug 31, 2004
W-2 Managing EmployeePresident/Ceo Jan 1, 1991 100%
Operational/Managerial ControlPresident/Ceo Jan 1, 1991
Skylar Creasman Individual Corporate DirectorBoard of Director Sep 1, 2021
Charles Ross Individual Corporate DirectorBoard Member May 1, 2022
Patti Dalton Individual Corporate Director Jan 1, 2010
Pearson Devaul Individual Corporate OfficerCoo Jan 1, 2019
W-2 Managing EmployeeCoo Jan 1, 2018
Linda Davis Individual Corporate Director Aug 12, 2010
Bill Hollin Individual Corporate Director Aug 12, 2010
Chandler Blakely Individual Corporate OfficerCfo Mar 1, 2021
W-2 Managing EmployeeChief Financial Officer Mar 1, 2021
Rita Hammons Individual Corporate Director Aug 12, 2010
John Myers Individual Corporate DirectorBoard Member May 30, 2014
Nelson Cope Individual Corporate Director Jan 1, 2019

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Benton Family Health Care CenterBenton, TN, CCN 441817 Federally qualified health center Operational/Managerial Control Jul 1, 1978
Grundy County Primary Care CenterCoalmont, TN, CCN 441867 Federally qualified health center Operational/Managerial Control Jan 1, 1990

Owned or controlled facilities with NPI records 2

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

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": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1760694665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 589",
            "city": "DECATUR",
            "state": "TN",
            "postal_code": "373220589",
            "telephone_number": "423-334-4154",
            "fax_number": "423-334-4195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 RIVER RD",
            "city": "DECATUR",
            "state": "TN",
            "postal_code": "373227801",
            "telephone_number": "423-334-4154",
            "fax_number": "423-334-4195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCOEE REGIONAL HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "MOATS",
        "authorized_official_first_name": "BILL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "423-338-8995",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meigs County Primary Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decatur, TN

Sources for this page

Verify at the official NPI Registry.