NPIMap

Organization Active NPI

Clarksville Physician Services, LLC

Doing business as Dover Medical Clinic

  • Rural Health Clinic/Center
  • Dover, TN
National Provider Identifier
1992077077
Registry record updated Feb 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLARKSVILLE PHYSICIAN SERVICES, LLC
Doing business as
Dover Medical Clinic
Vanderbilt Primary Care Dover
Practice address
133 Dr Robert H Lee Road
Dover, TN 37058-3750
Phone
(931) 232-5141
Fax
(931) 232-3905
NPI assigned
Feb 3, 2012
Last updated
Feb 3, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2026

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

Authorized official

Name
Wendy Monaci
Title
President
Phone
(615) 936-3944

Specialties & licenses 1

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

Addresses

Primary practice location

133 Dr Robert H Lee Road
Dover, TN 37058-3750

Mailing address

3841 Green Hills Village Dr Ste 200
Nashville, TN 37215-2691

Other names 2

  • Dover Medical Clinic Doing business as
  • Vanderbilt Primary Care Dover Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120328000305 TN Part A Provider - Rural Health Clinic 0547276917 Practice locations: Dover, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992077077. Details of each certification follow.

Rural health clinic certification: CCN 448914

Legal name
CLARKSVILLE PHYSICIAN SERVICES, LLC
Doing business as
VANDERBILT PRIMARY CARE DOVER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 12, 2012
Last certification
Apr 23, 2024
Ownership / control type
1B
Organization structure
LLC
Incorporated
Sep 19, 2005 in DE
Enrollment address
133 Dr Robert Lee Rd
Dover, TN 37058-0018

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
44D0306809Clarksville Physician Services, LLC133 Dr Robert H Lee Drive, Dover, TN 37058Certificate of waiverJun 14, 2027

National Provider Directory

National Provider Directory
Part of
Clarksville Physician

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Vanderbilt Montgomery Holdings LLC Organization, Nashville, TN LLC 5% Or Greater Direct Ownership Interest Dec 31, 2020 100%
Folabi Ibrahim Ariganjoye Individual W-2 Managing EmployeeMD; Feb 1, 2026
Angela Simmons Individual W-2 Managing EmployeeVice President - Finance Feb 1, 2026
Karen Nanney Individual Corporate OfficerSecretary Feb 1, 2026
Wendy Monaci Individual Corporate OfficerVice President Feb 1, 2026
W-2 Managing EmployeeVice President Feb 1, 2026
Vanderbilt University Medical Center Organization, Nashville, TN Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Dec 21, 2020
Megan Youngblood Individual Corporate OfficerVice President Feb 1, 2026
Rick W Wright Individual Corporate OfficerPresident Feb 1, 2026

Owners & managing parties with NPI records 13

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

View all 13

Facilities with the same owner 19

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

View all 19

Practitioners & affiliated clinicians

Practitioners 76

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 76

NPI Registry JSON

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

{
    "created_epoch": "1328227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770076800000",
    "number": "1992077077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 GREEN HILLS VILLAGE DR STE 200",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372152691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 DR ROBERT H LEE ROAD",
            "city": "DOVER",
            "state": "TN",
            "postal_code": "370583750",
            "telephone_number": "931-232-5141",
            "fax_number": "931-232-3905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSVILLE PHYSICIAN SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-03",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A",
        "authorized_official_last_name": "MONACI",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-936-3944"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dover Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vanderbilt Primary Care Dover",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dover, TN

Sources for this page

Verify at the official NPI Registry.