NPIMap

Organization Active NPI

Family Medicine West PLLC

Doing business as Family Medicine West of Wartburg

  • Rural Health Clinic/Center
  • Wartburg, TN
National Provider Identifier
1902292865
Registry record updated Apr 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAMILY MEDICINE WEST PLLC
Doing business as
Family Medicine West of Wartburg
Practice address
1236 Knoxville Hwy
Suite 500
Wartburg, TN 37887-4200
Phone
(423) 346-5566
Fax
(423) 346-5631
NPI assigned
Apr 7, 2015
Last updated
Apr 7, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2015

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

Authorized official

Name
Dr. Sanjay P Thankur, M.D.
Title
MD/President
Phone
(423) 346-5566

Specialties & licenses 1

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

Addresses

Primary practice location

1236 Knoxville Hwy
Suite 500
Wartburg, TN 37887-4200

Mailing address

220 Fort Sanders West Blvd
Building 2, Suite 200
Knoxville, TN 37922-3398
Phone (423) 346-5566

Other names 1

  • Family Medicine West of Wartburg Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150615001198 TN Part A Provider - Rural Health Clinic 7618126608 Practice locations: Wartburg, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902292865. Details of each certification follow.

Rural health clinic certification: CCN 448952

Legal name
FAMILY MEDICINE WEST PLLC
Doing business as
FAMILY MEDICINE WEST OF WARTBURG
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 24, 2015
Last certification
Dec 7, 2021
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
Jul 25, 2012 in TN
Enrollment address
1236 Knoxville Highway
Suite 500
Wartburg, TN 37887-4200

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
44D2048018Family Medicine West, PLLC1236 Knoxville Hwy Ste 500, PO Box 308, Wartburg, TN 37887Certificate of waiverOct 7, 2026

National Provider Directory

National Provider Directory

Locations

817 Cook Dr
Athens, TN 37303
Phone (423) 745-3394

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
Sanjay P Thakur Individual 5% Or Greater Direct Ownership Interest Jul 25, 2012 100%
Corporate DirectorPresident Jul 25, 2012 100%
W-2 Managing Employee Jul 25, 2012 100%
Operational/Managerial ControlPresident Jul 25, 2012 100%

Owners & managing parties with NPI records 1

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

  • Sanjay P Thakur, M.D.
    • Family Medicine Physician
    • Wartburg, TN
    • NPI 1699816074

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

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428364800000",
    "number": "1902292865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 FORT SANDERS WEST BLVD",
            "address_2": "BUILDING 2, SUITE 200",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379223398",
            "telephone_number": "423-346-5566",
            "fax_number": "423-346-5631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1236 KNOXVILLE HWY",
            "address_2": "SUITE 500",
            "city": "WARTBURG",
            "state": "TN",
            "postal_code": "378874200",
            "telephone_number": "423-346-5566",
            "fax_number": "423-346-5631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE WEST PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-07",
        "last_updated": "2015-04-07",
        "status": "A",
        "authorized_official_last_name": "THANKUR",
        "authorized_official_first_name": "SANJAY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MD/PRESIDENT",
        "authorized_official_telephone_number": "423-346-5566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine West of Wartburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wartburg, TN

Sources for this page

Verify at the official NPI Registry.