Ocoee Regional Health Corporation
Organization Active NPI Federally Qualified Health Center (FQHC) · Coalmont, TN
NPI 1902010770 · NPPES record last updated Jun 29, 2021
Key facts
- NPI
- 1902010770
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- OCOEE REGIONAL HEALTH CORPORATION
- Practice address
- 10120 Sr 56
Coalmont, TN 37313-2505 - Phone
- (931) 779-4002
- Fax
- (931) 779-4003
- NPI assigned
- May 10, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Bill R Moats
- Title
- Ceo
- Phone
- (423) 338-8995
Owners & managing parties with NPI records 11
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 11
Facilities with the same owner 1
Practitioners 32
-
Julie Mae Brewer, M.D.
-
Pamela P Jones-Singleton, FNP-BC
-
Patricia Anne Mitchum, M.D.
-
Leah T Elrod, FNP
-
Susan G Fisher, MD
-
Lauren Rhea Gibson, FNP-BC
-
Robin Lee Harding, M.D.
-
Jessica Joslyn, NP
-
Robert Breck Lang, FNP
-
Denise Renee McCluskey, FNP-C
-
Sally Moss, APN REGISTERED NURSE
-
Mercedes V. Payne, M.D.
-
Kayla Tanyee Perry, MSN
-
Cathy Smith Phillips, AANP-C
-
Jessica Ann Reid, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0904148 | Grundy County Primary Care Center | Compliance | Jan 6, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Federally qualified health center certification: CCN 441867
- Legal name
- OCOEE REGIONAL HEALTH CORPORATION
- Doing business as
- GRUNDY COUNTY PRIMARY CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 25, 1994
- Last certification
- Jul 25, 1994
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 22, 1978 in TN
- Enrollment address
- 10120 Sr 56
Coalmont, TN 37313-2505
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Kimberly Bishop |
Corporate Director | Aug 12, 2010 | |
| Ocoee Regional Health Corporation |
Operational/Managerial Control | Jan 1, 1990 | |
| William Moats |
Corporate Director |
Aug 12, 2010 | |
| W-2 Managing Employee |
Aug 12, 2010 | ||
| Skylar Creasman |
Corporate Officer |
May 1, 2021 | |
| Charles Ross |
Corporate Officer |
Jun 1, 2022 | |
| Patti Dalton |
Corporate Director | Nov 3, 2010 | |
| Pearson Devaul |
W-2 Managing Employee |
Jan 1, 2018 | |
| Linda Davis |
Corporate Director | Aug 12, 2010 | |
| Bill Hollin |
Corporate Director | Aug 12, 2010 | |
| Chandler Blakely |
Corporate Officer |
Mar 1, 2021 | |
| W-2 Managing Employee |
Mar 1, 2021 | ||
| Rita Hammons |
Corporate Director | Aug 12, 2010 | |
| John Myers |
Corporate Director | May 1, 2014 | |
| Nelson Cope |
Corporate Director |
Jan 1, 2020 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Benton Family Health Care Center |
Federally qualified health center | Operational/Managerial Control | Jul 1, 1978 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040412001630 | TN | Part B Supplier - Clinic/Group Practice | 1355233693 |
Receives reassigned benefits from 32 practitioners 1 other NPI on this enrollment Practice locations: Decatur, TN; Pikeville, TN; Dayton, TN; Coalmont, TN; Cleveland, TN; Benton, TN |
| O20100820001096 | TN | Part a Provider - Federally Qualified Health Center (FQHC) | 1355233693 | Practice locations: Coalmont, TN |
National Provider Directory
Locations
1420 Fritz St SE
Cleveland, TN 37323
Phone (423) 380-6383
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
10120 Sr 56
Coalmont, TN 37313-2505
Mailing address
PO Box 70
Palmer, TN 37365-0070
Phone (931) 779-4002
Other names
- Grundy County Primary Care Center
Other providers in Coalmont, TN
- Exceptional Enterprises, Inc.
- Franklin Emergency Medical Services, Inc.
- Grundy Emergency Medical Service Inc
- Jessica Joslyn
- Patricia Anne Mitchum
- Palmer Drug, LLC
- Jessica Ann Reid
- Ashley Ann Sartain
All providers in Coalmont, 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 Jun 29, 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.