Organization Active NPI

Michie Medical Clinic, Inc.

  • Rural Health Clinic/Center
  • Michie, TN
National Provider Identifier
1861695900
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MICHIE MEDICAL CLINIC, INC.
Practice address
6659 Michie Pebble Hill Rd
Michie, TN 38357-5115
Phone
(731) 632-1783
NPI assigned
Jun 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

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

Authorized official

Name
Brandon K Sumler
Title
Director
Phone
(731) 632-1783

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X APN0000006617 TN
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

6659 Michie Pebble Hill Rd
Michie, TN 38357-5115

Mailing address

6659 Michie Pebble Hill Rd
Michie, TN 38357-5115
Phone (731) 632-1783

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050819000837 TN Part B Supplier - Clinic/Group Practice 6608806500 Receives reassigned benefits from 2 practitioners
Practice locations: Michie, TN
O20131115001528 TN Part A Provider - Rural Health Clinic 6608806500 Practice locations: Michie, TN

Rural health clinic certification: CCN 448932

Legal name
MICHIE MEDICAL CLINIC INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 28, 2014
Last certification
Dec 12, 2022
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Oct 11, 2001 in TN
Enrollment address
6659 Michie Pebble Hill Rd
Michie, TN 38357-5115

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
44D0957508Michie Medical Clinic Inc6659 Michie Pebble Hill Road, Michie, TN 38357Certificate of waiverFeb 20, 2028

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.400014

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Campbell and Ford Construction Organization, Michie, TN Corporation, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 21, 2025 100%
Michael Campbell Individual 5% Or Greater Indirect Ownership InterestPresident Aug 21, 2025 50%
Corporate OfficerPresident Aug 21, 2025 50%
Operational/Managerial ControlPresident Aug 21, 2025 50%
Andre Ford Individual 5% Or Greater Indirect Ownership InterestVice President Aug 21, 2025 50%
Corporate OfficerVice President Aug 21, 2025 50%
Operational/Managerial ControlVice President Aug 21, 2025 50%
Brandon Sumler Individual Corporate OfficerSecretary Aug 21, 2025
W-2 Managing EmployeeSecretary Aug 21, 2025

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758585600000",
    "number": "1861695900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6659 MICHIE PEBBLE HILL RD",
            "city": "MICHIE",
            "state": "TN",
            "postal_code": "383575115",
            "telephone_number": "731-632-1783",
            "fax_number": "731-632-1786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6659 MICHIE PEBBLE HILL RD",
            "city": "MICHIE",
            "state": "TN",
            "postal_code": "383575115",
            "telephone_number": "731-632-1783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIE MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A",
        "authorized_official_last_name": "SUMLER",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "731-632-1783"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": "APN0000006617",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Michie, TN

Sources for this page

Verify at the official NPI Registry.