NPIMap

Organization Active NPI

Madisonville Primary Care Group PLLC

Doing business as United Primary Care Etowah

  • Rural Health Clinic/Center
  • Etowah, TN
National Provider Identifier
1780304238
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MADISONVILLE PRIMARY CARE GROUP PLLC
Doing business as
United Primary Care Etowah
Practice address
723 N Tennessee Ave
Etowah, TN 37331-1754
Phone
(423) 263-2100
Fax
(423) 781-7662
NPI assigned
Sep 2, 2022
Last updated
Nov 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

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

Authorized official

Name
Gregory Brian CainNPI 1528388592
Title
PA-C, Owner
Phone
(423) 442-2121

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

723 N Tennessee Ave
Etowah, TN 37331-1754

Mailing address

PO Box 808
Kingston, TN 37763-0808
Phone (865) 224-7172

Other names 1

  • United Primary Care Etowah Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110921000012 TN Part B Supplier - Clinic/Group Practice 6507037645 Receives reassigned benefits from 9 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Athens, TN; Etowah, TN; Madisonville, TN
O20220929002072 TN Part A Provider - Rural Health Clinic 6507037645 Practice locations: Etowah, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780304238. Details of each certification follow.

Rural health clinic certification: CCN 883935

Legal name
MADISONVILLE PRIMARY CARE GROUP PLLC
Doing business as
UNITED PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 13, 2023
Last certification
Feb 13, 2023
Ownership / control type
1A
Organization structure
LLCProprietary
Enrollment address
723 N Tennessee Ave
Etowah, TN 37331-1754

Other NPIs with the same Medicare PAC ID 2

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
44D2163639United Primary Care723 N Tennessee Ave, Etowah, TN 37331Certificate of waiverMar 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
Madisonville Primary Care Group PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

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.

NameRoleSinceShare
Gregory B Cain Individual 5% Or Greater Direct Ownership Interest Jul 7, 2011 99%
Corporate OfficerCeo Jul 7, 2011 99%
W-2 Managing EmployeeCeo Jul 7, 2011 99%
Operational/Managerial ControlCeo Jul 7, 2011 99%

Owners & managing parties with NPI records 1

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

  • Gregory Brian Cain, PA-C
    • Medical Physician Assistant
    • Madisonville, TN
    • NPI 1528388592

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

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": "1662076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730678400000",
    "number": "1780304238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 808",
            "city": "KINGSTON",
            "state": "TN",
            "postal_code": "377630808",
            "telephone_number": "865-224-7172",
            "fax_number": "865-224-7171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 N TENNESSEE AVE",
            "city": "ETOWAH",
            "state": "TN",
            "postal_code": "373311754",
            "telephone_number": "423-263-2100",
            "fax_number": "423-781-7662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISONVILLE PRIMARY CARE GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-02",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A",
        "authorized_official_last_name": "CAIN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "PA-C, OWNER",
        "authorized_official_telephone_number": "423-442-2121"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "United Primary Care Etowah",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Etowah, TN

Sources for this page

Verify at the official NPI Registry.