Jefferson County Nursing Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

JEFFERSON COUNTY NURSING HOME

Practice address

407 Laura Lee Dr
White Pine, TN 37890

Phone

(865) 327-4100

NPI assigned

Aug 30, 2022

Last updated

Aug 30, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

JEFFERSON COUNTY NURSING HOMEAs reported in NPPES

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

Authorized official

Name

Mr. Roger Louis Mynatt, LNHA

Title

Administrator

Phone

(865) 397-3163

Specialties & licenses 1

Addresses

Other names 1

• Jefferson Park At White Pine Other name

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982324182. Details of each certification follow.

• CCN 445542 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 445542

Legal name

JEFFERSON COUNTY NURSING HOME

Doing business as

JEFFERSON PARK AT WHITE PINE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Oct 25, 2023

Last certification

Oct 24, 2023

Beds

30

Ownership / control type

County

Organization structure

GovernmentNon-profit

Incorporated

in TN

Enrollment address

407 Laura Lee Dr
White Pine, TN 37890-3500

Nursing home name

JEFFERSON PARK AT WHITE PINE

Other NPIs with the same Medicare PAC ID 1

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

• Jefferson County Nursing Home

  • Skilled Nursing Facility
  • Dandridge, TN
  • NPI 1285624361

  3072414135

  Same PAC ID

Listed as

Jefferson Park at White PineCCN 445542 · All quality measures

Overall star rating

4 of 5

Health inspections

4 of 5

Staffing

4 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

Government - County

Certified

Oct 25, 2023

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

3028.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Tax ID family

Jefferson Co Nursing Home2 organizations share this tax ID, including this one

Part of

Jefferson Co Nursing Home

Other organizations with this tax ID 1

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

• Jefferson County Nursing Home

  • Skilled Nursing Facility
  • Dandridge, TN
  • NPI 1285624361
  NPD tax ID

All disclosed owners & managing parties 3

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

Owners & managing parties with NPI records 1

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

• Jefferson County Nursing Home

  • Skilled Nursing Facility
  • Dandridge, TN
  • NPI 1285624361

  Other

  CMS ownership

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Jefferson County Nursing Home

  • Skilled Nursing Facility
  • Dandridge, TN
  • NPI 1285624361
  NPPES parent name

Practitioners 1

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.

• Rual Swanson, MD

  • Family Medicine Physician
  • Dandridge, TN
  • NPI 1174529432
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Rual Swanson, MD

  • Family Medicine Physician
  • Dandridge, TN
  • NPI 1174529432

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661817600000",
    "number": "1982324182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 INDUSTRIAL PARK RD",
            "city": "DANDRIDGE",
            "state": "TN",
            "postal_code": "377254700",
            "telephone_number": "865-397-3163",
            "fax_number": "865-397-3333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 LAURA LEE DR",
            "city": "WHITE PINE",
            "state": "TN",
            "postal_code": "37890",
            "telephone_number": "865-327-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COUNTY NURSING HOME",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JEFFERSON COUNTY NURSING HOME",
        "enumeration_date": "2022-08-30",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-18",
        "status": "A",
        "authorized_official_last_name": "MYNATT",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "865-397-3163",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Park At White Pine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Skilled Nursing Facility in White Pine, TN
• Providers in White Pine, TN by specialty
• Skilled Nursing Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.