NPIMap

Saint Thomas River Park Hospital, LLC

Organization Active NPI Rural Health Clinic/Center · Sparta, TN

NPI 1972193191 · NPPES record last updated Jun 28, 2024

Key facts

NPI
1972193191
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
SAINT THOMAS RIVER PARK HOSPITAL, LLC
Practice address
435 Sewell Dr
Sparta, TN 38583-1223
Phone
(931) 738-4595
NPI assigned
Jan 21, 2021
Organization subpart
Yes
Parent organization (as reported)
SAINT THOMAS RIVER PARK HOSPITAL, LLC

Authorized official

Name
Candace Garrett
Title
Manager of Business Operations
Phone
(615) 290-7184

Owners & managing parties with NPI records 5

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

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 5

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

Corporate family (same tax ID) 10

Organizations that report the same tax identification number in the National Provider Directory.

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 7

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D1044264Saint Thomas River Park Hospital, LLC
435 Sewell Dr, Sparta, TN 38583		Provider-performed microscopyAug 14, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TN

Rural health clinic certification: CCN 443476

Legal name
SAINT THOMAS RIVER PARK HOSPITAL, LLC
Doing business as
AMG SAINT THOMAS SPARTA PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 2, 2021
Last certification
Sep 2, 2021
Ownership / control type
2B
Organization structure
LLC · Non-profit
Incorporated
May 15, 2015 in TN
Enrollment address
435 Sewell Dr
Sparta, TN 38583-1200
Related CCNs
440151

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
Brandon Williams
Individual 		Corporate Director
Cfo		 Oct 31, 2022
Lynn Dion Miller
Individual 		W-2 Managing Employee
Director		 Mar 10, 2021 100%
Saint Thomas River Park Hospital, LLC
Organization · McMinnville, TN
LLC, Non-profit 		5% Or Greater Direct Ownership Interest Mar 10, 2021 100%
Lisa Davis
Individual 		Corporate Officer
Cfo		 Mar 10, 2021 100%

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Amg Saint Thomas Woodlee Family Practice
McMinnville, TN · CCN 443473		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 10, 2021
Ascension Saint Thomas River Park
McMinnville, TN · CCN 443475		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 10, 2021
Amg Saint Thomas Cookeville Primary Care
Cookeville, TN · CCN 443474		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 10, 2021

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20210317000215 TN Part a Provider - Rural Health Clinic 7214246156 Practice locations: Sparta, TN

National Provider Directory

Tax ID family
Saint Thomas River Park Hospital LLC (11 organizations share this tax ID)
Part of
Saint Thomas River Park Hospital LLC

Locations

435 Sewell Dr
Sparta, TN 38583
Phone (931) 738-4595

Specialties & licenses

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

Addresses

Primary practice location

435 Sewell Dr
Sparta, TN 38583-1223

Mailing address

300 20TH Ave N Ste 403
Nashville, TN 37203-5180
Phone (615) 289-3257

Other names

  • AMG Saint Thomas Sparta Primary Care Doing business as
  • Ascension Medical Group Saint Thomas Sparta Primary Care Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 28, 2024.

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1972193191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 20TH AVE N STE 403",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372035180",
            "telephone_number": "615-289-3257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 SEWELL DR",
            "city": "SPARTA",
            "state": "TN",
            "postal_code": "385831223",
            "telephone_number": "931-738-4595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT THOMAS RIVER PARK HOSPITAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAINT THOMAS RIVER PARK HOSPITAL, LLC",
        "enumeration_date": "2021-01-21",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "GARRETT",
        "authorized_official_first_name": "CANDACE",
        "authorized_official_title_or_position": "MANAGER OF BUSINESS OPERATIONS",
        "authorized_official_telephone_number": "615-290-7184"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AMG Saint Thomas Sparta Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ascension Medical Group Saint Thomas Sparta Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sparta, TN

All providers in Sparta, TN · Rural Health Clinic/Center in Tennessee

Sources for this page

Verify at the official NPI Registry.