Rural Health Services Consortium of Upper East Tennessee Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Bluff City, TN
NPI 1972503753 · NPPES record last updated Oct 10, 2008
Key facts
- NPI
- 1972503753
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
- Practice address
- 229 Highway 19 E
Bluff City, TN 37618-1865 - Phone
- (423) 538-5116
- Fax
- (423) 538-3861
- NPI assigned
- Jul 22, 2005
- Organization subpart
- No
Authorized official
- Name
- Mrs. Wanda Brown
- Title
- Credentialing Administrator
- Phone
- (423) 272-9163
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 13
Other NPIs with the same Medicare PAC ID 12
Practitioners 50
-
Brandy Reshea Ball, FNP
-
Emily Faye Benfield, FNP
-
Mica Lauren Brown, FNP
-
Samuel Brown, FNP
-
Amanda Dawn Cornett, FNP
-
Nancy Anne Crider, LPC
-
Mark Joseph Dalle-Ave, M.D.
-
Mark R Doman, M.D.
-
Kristen Dykes, FNP
-
Leslie Renee Elliott, FNP-BC
-
Ann Elizabeth Espey, APN
-
Phyllis C Fisher, FNP
-
Rachiel Erin Gibson, PA-C
-
Jamesia Hicks Harris, NP-C
-
Duskin Henard, DPT
-
Amy Romeo Herron, LCSW
-
Michael E Hill, NP-C
-
Kelly Jane Hopkins, FNP
-
Jennifer E. Lane, N.P.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0310740 | Bluff City Medical Center | Certificate of waiver | Dec 17, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Federally qualified health center certification: CCN 441814
- Legal name
- RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 21, 1985 in TN
- Enrollment address
- 229 Highway 19 E
Bluff City, TN 37618-1865
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Linda W. Buck |
Corporate Director | Sep 19, 2008 | |
| W-2 Managing Employee | Sep 19, 2008 | ||
| Amelia E Bailey |
Corporate Director |
Mar 25, 2021 | |
| Cloyce Eller |
Corporate Director | Sep 19, 2008 | |
| Geren Michael Street |
Corporate Director |
Jul 23, 2020 | |
| Minnie Miller |
Corporate Director | Apr 1, 2012 | |
| Terry Cunningham |
Corporate Director | Sep 19, 2008 | |
| Jacqueline Charles |
Corporate Director | Sep 19, 2008 | |
| Charles R Huffman |
Corporate Director |
Oct 24, 2019 | |
| Joseph Paul Frye |
Corporate Director | Sep 19, 2008 | |
| Timothy R Smithson |
Corporate Director |
Apr 1, 2019 | |
| Betty Greene |
Corporate Director | Sep 19, 2008 | |
| Charles Herman Heck |
Corporate Director |
Sep 22, 2016 | |
| Lorena Reynoso |
Corporate Director |
Jul 25, 2019 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Rogersville Medical Complex |
Federally qualified health center | Operational/Managerial Control | Dec 30, 2013 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031107000207 | TN | Part B Supplier - Clinic/Group Practice | 0941118111 |
Receives reassigned benefits from 54 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Rogersville, TN; Sneedville, TN; Kingsport, TN |
| O20080930000315 | TN | Part a Provider - Federally Qualified Health Center (FQHC) | 0941118111 | Practice locations: Bluff City, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
229 Highway 19 E
Bluff City, TN 37618-1865
Mailing address
PO Box 850
Rogersville, TN 37857-0850
Phone (423) 272-9163
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4448150 | Medicaid | TN | |
| 020845900 | Other | BLACK LUNG | |
| 3703866 | Other | CIGNA / MEDICARE | |
| 4122525 | Other | TN | BLUECROSS BLUESHIELD |
Other names
- Bluff City Medical Center
Other providers in Bluff City, TN
- Jayson Andrew Marcarelli
- Pedram Mir Aghazadeh
- Logan Chayse Nutter
- Kaushal Patel
- Catherine H Powers
- Jonathan Todd Simmons
- Tina Marie Smith
- Sullivan County Regional Health Dept.
- Deepika A Tumkur
- Jamie Bare Vance
All providers in Bluff City, 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 Oct 10, 2008. 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.