Ocoee Regional Health Corporation
Organization Active NPI Federally Qualified Health Center (FQHC) · Dayton, TN
NPI 1831862879 · NPPES record last updated Jul 27, 2021
Key facts
- NPI
- 1831862879
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- OCOEE REGIONAL HEALTH CORPORATION
- Practice address
- 1005 Delaware Ave
Dayton, TN 37321-2818 - Phone
- (423) 338-8995
- NPI assigned
- Jul 27, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- OCOEE REGIONAL HEALTH CORPORATION
Authorized official
- Name
- William Moats
- Title
- Ceo/President
- Phone
- (423) 338-8995
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 13
Practitioners 5
-
Julie Mae Brewer, M.D.
-
Pamela P Jones-Singleton, FNP-BC
-
Patricia Anne Mitchum, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2175265 | Rhea Central Elementary School | Certificate of waiver | Nov 18, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Federally qualified health center certification: CCN 441015
- Legal name
- OCOEE REGIONAL HEALTH CORPORATION
- Doing business as
- RHEA CENTRAL ELEMENTARY SCHOOL
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 2, 2021
- Last certification
- Sep 2, 2021
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 1, 1978 in TN
- Enrollment address
- 1005 Delaware Ave
Dayton, TN 37321-2818
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Kimberly Bishop |
Corporate Director | Jan 1, 1997 | |
| Ruth Creasman |
Corporate Director | Jan 1, 1992 | |
| William Moats |
Corporate Officer |
Jan 1, 1990 | 100% |
| W-2 Managing Employee |
Jan 1, 1990 | 100% | |
| Patti Dalton |
Corporate Director | Jan 1, 2000 | |
| Evelio Hidalgo-Barrionuevo |
Corporate Director | May 27, 2021 | |
| Pearson Devaul |
Corporate Officer |
Jan 1, 2019 | |
| Linda Davis |
Corporate Director | Jan 1, 1990 | |
| Bill Hollin |
Corporate Director | Jan 1, 1995 | |
| Chandler Blakely |
Corporate Officer |
Mar 1, 2021 | |
| Judy Reynolds |
Corporate Director | Jan 1, 2015 | |
| Rita Hammons |
Corporate Director | Jan 1, 2000 | |
| John Myers |
Corporate Director | Apr 1, 2015 | |
| Nelson Cope |
Corporate Director | Jan 1, 2019 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Benton Family Health Care Center |
Federally qualified health center | Operational/Managerial Control | Jul 1, 1978 |
| Grundy County Primary Care Center |
Federally qualified health center | Operational/Managerial Control | Jan 1, 1990 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210913001503 | TN | Part a Provider - Federally Qualified Health Center (FQHC) | 1355233693 | Practice locations: Dayton, TN |
National Provider Directory
- Tax ID family
- Rhea County PR Imary Care
- Part of
- Rhea County PR Imary Care
Locations
1005 Delaware Ave
Dayton, TN 37321
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1005 Delaware Ave
Dayton, TN 37321-2818
Mailing address
PO Box 308
Benton, TN 37307-0308
Phone (423) 338-8995
Other names
- Rhea Central Elementary School
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Benton |
Other providers in Dayton, TN
- Miranda Renee Neuberg
- Nicole J. Kammeyer, O.D.
- Ocoee Regional Health Corporation
- Ocoee Regional Health Corporation
- Ocoee Regional Health Corporation
- Mark R Ofenloch
- Opulent Healthcare
- Kathryn Orten
- Sharon Eileen Oxentenko
- Sarah Parker
All providers in Dayton, TN · Federally Qualified Health Center (FQHC) in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.