Main Street Family Care PLLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

MAIN STREET FAMILY CARE PLLC

Practice address

211 Church St
Tiptonville, TN 38079-1109

Phone

(731) 571-0569

NPI assigned

Jun 6, 2017

Last updated

Oct 31, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Misty C Barker, NP-CNPI 1407999683

Title

NP/Owner

Phone

(731) 571-0569

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770012676. Details of each certification follow.

• CCN 448987 Rural health clinic · Active · Details

Rural health clinic certification: CCN 448987

Legal name

MAIN STREET FAMILY CARE PLLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Dec 12, 2017

Last certification

Sep 24, 2024

Ownership / control type

1A

Organization structure

LLCProprietary

Enrollment address

211 Church St
Tiptonville, TN 38079-1109

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Misty C Barker, APN

  • Family Nurse Practitioner
  • Tiptonville, TN
  • NPI 1407999683

  Corporate Director, Corporate Officer, W-2 Managing Employee

  CMS ownership

Practitioners 2

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.

• Misty C Barker, APN

  • Family Nurse Practitioner
  • Tiptonville, TN
  • NPI 1407999683
  Medicare reassignment NPD Authorized official
• Kerri A Ervin, FNP

  • Family Nurse Practitioner
  • Tiptonville, TN
  • NPI 1689914632
  NPD

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572480000000",
    "number": "1770012676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 CHURCH ST",
            "city": "TIPTONVILLE",
            "state": "TN",
            "postal_code": "380791109",
            "telephone_number": "731-571-0569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 CHURCH ST",
            "city": "TIPTONVILLE",
            "state": "TN",
            "postal_code": "380791109",
            "telephone_number": "731-571-0569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET FAMILY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-06",
        "last_updated": "2019-10-31",
        "status": "A",
        "authorized_official_last_name": "BARKER",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "NP/OWNER",
        "authorized_official_telephone_number": "731-571-0569",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Norma Jean Johnson, BOC ABC
• Courtney Kent, PMHNP
• Terra Micah King, APRN, FNP-C
• Fernando Cardenas Lagrimas, M.D
• Lake County Primary Care
• Valerie Cagle Makin, RN
• John Mancell, PHARM D
• James Francis McCallen III, D.D.S.
• Erle Ridley Mulherin III, PHARMACIST
• National Assistance Bureau, Inc. (Reelfoot Manor)

• Rural Health Clinic/Center in Tiptonville, TN
• Providers in Tiptonville, TN by specialty
• Rural Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.