NPIMap

Organization Active NPI

Family Care Clinic LLC

  • Rural Health Clinic/Center
  • McMinnville, TN
National Provider Identifier
1780924456
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAMILY CARE CLINIC LLC
Practice address
306 N Chancery St
McMinnville, TN 37110-2048
Phone
(931) 474-4700
Fax
(931) 474-4701
NPI assigned
Feb 18, 2013
Last updated
Jan 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

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

Authorized official

Name
Mrs. Theresa Herrin Hill, APNNPI 1699785709
Title
Owner
Phone
(931) 474-4700

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

306 N Chancery St
McMinnville, TN 37110-2048

Mailing address

306 N Chancery St
McMinnville, TN 37110-2048
Phone (931) 474-4700

Other identifiers 3

IdentifierTypeStateIssuer
01032615OtherTNAMERIGROUP
3649680MedicaidTN
TN0101OtherTNAMERICHOICE

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130513000391 TN Part B Supplier - Clinic/Group Practice 8729225677 Receives reassigned benefits from 20 practitioners
Practice locations: McMinnville, TN
O20140612002370 TN Part A Provider - Rural Health Clinic 8729225677 Practice locations: McMinnville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780924456. Details of each certification follow.

Rural health clinic certification: CCN 448941

Legal name
FAMILY CARE CLINIC LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 3, 2014
Last certification
Jul 28, 2021
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
Feb 15, 2011 in TN
Enrollment address
306 N Chancery St
McMinnville, TN 37110-2048

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
44D2020484Family Care Clinic, LLC306 N Chancery Street, McMinnville, TN 37110ComplianceJan 12, 2027

National Provider Directory

National Provider Directory

Locations

231 Northgate Dr
Ste 102
McMinnville, TN 37110
Phone (931) 474-4700

306 N Chancery St
McMinnville, TN 37110
Phone (931) 474-4700

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
Theresa H Hill Individual 5% Or Greater Direct Ownership InterestOwner Feb 15, 2011 100%
W-2 Managing EmployeeOwner Feb 15, 2011 100%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1361145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1780924456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 N CHANCERY ST",
            "city": "MCMINNVILLE",
            "state": "TN",
            "postal_code": "371102048",
            "telephone_number": "931-474-4700",
            "fax_number": "931-474-4701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 N CHANCERY ST",
            "city": "MCMINNVILLE",
            "state": "TN",
            "postal_code": "371102048",
            "telephone_number": "931-474-4700",
            "fax_number": "931-474-4701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-18",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "HERRIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-474-4700",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APN"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01032615",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3649680",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE",
            "identifier": "TN0101",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McMinnville, TN

Sources for this page

Verify at the official NPI Registry.