NPIMap

Organization Active NPI

Upper Cumberland Rural Health Clinic PLLC

Doing business as Crossville Medical Clinic RHC

  • Rural Health Clinic/Center
  • Crossville, TN
National Provider Identifier
1780296863
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC
Doing business as
Crossville Medical Clinic RHC
Practice address
820 N Main St
Crossville, TN 38555-4024
Phone
(931) 250-5230
NPI assigned
Aug 19, 2020
Last updated
Jun 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Authorized official

Name
Navin Jain
Title
Cfo
Phone
(931) 528-8899

Specialties & licenses 1

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

Addresses

Primary practice location

820 N Main St
Crossville, TN 38555-4024

Mailing address

225 N Willow Ave
Cookeville, TN 38501-2335

Other names 1

  • Crossville Medical Clinic RHC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200930000293 TN Part A Provider - Rural Health Clinic 8820198138 Practice locations: Crossville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780296863. Details of each certification follow.

Rural health clinic certification: CCN 883837

Legal name
UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC
Doing business as
CROSSVILLE MEDICAL CLINIC RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 18, 2021
Last certification
Feb 3, 2021
Ownership / control type
1A
Organization structure
LLCProprietary
Enrollment address
820 N Main St
Crossville, TN 38555-4024

Other NPIs with the same Medicare PAC ID 8

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
44D2276899Upper Cumberland Rural Health Clinic, PLLC820 Main St, Crossville, TN 38555Certificate of waiverFeb 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
Baxter Medical Clinic RHC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

229 Interstate Dr
Ste 105
Crossville, TN 38555
Phone (931) 250-5230

820 N Main St
Crossville, TN 38555
Phone (931) 250-5230

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Cookeville Intermediate, PA Organization, Cookeville, TN Corporation 5% Or Greater Direct Ownership Interest Apr 28, 2023 100%
Pushpendra K Jain Individual 5% Or Greater Indirect Ownership Interest Apr 28, 2023 100%
Corporate OfficerPresident Jul 31, 2020 100%
Operational/Managerial ControlPresident Jul 31, 2020 100%
Alexis Barbour Individual Corporate Officer Apr 28, 2023

Owners & managing parties with NPI records 1

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

  • Pushpendra K Jain, MD
    • Family Medicine Physician
    • Cookeville, TN
    • NPI 1689748634

    5% Or Greater Indirect Ownership Interest, Corporate Officer, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 3

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

NPI Registry JSON

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

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1780296863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 N WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 N MAIN ST",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554024",
            "telephone_number": "931-250-5230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER CUMBERLAND RURAL HEALTH CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-19",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "JAIN",
        "authorized_official_first_name": "NAVIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "931-528-8899"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossville Medical Clinic RHC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crossville Medical Clinic RHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crossville, TN

Sources for this page

Verify at the official NPI Registry.