Premier Family Care Inc.
Organization Active NPI Family Medicine Physician · Scotts Hill, TN
NPI 1992338644 · NPPES record last updated Mar 4, 2021
Key facts
- NPI
- 1992338644
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- PREMIER FAMILY CARE INC.
- Practice address
- 9458 Highway 100
Scotts Hill, TN 38374-6443 - Phone
- (731) 549-2600
- NPI assigned
- Feb 20, 2020
- Organization subpart
- No
Authorized official
- Name
- Danny Pope
- Title
- President
- Phone
- (731) 549-2600
Owners & managing parties with NPI records 1
-
Penny J Pope, FNP
Practitioners 7
-
Laura Brasher, FNP
-
Penny J Pope, FNP
-
Betty A Roe, APN BC
-
Jami Lane Ivey, LCSW, LADAC
-
Amy B Mitchell, AGPCNP-BC
-
Joshua Krebs, MS, LPC
-
Megan Elise Ethredge, LPC/MHSP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2180992 | Premier Family Care Inc | Certificate of waiver | Mar 23, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Rural health clinic certification: CCN 883835
- Legal name
- PREMIER FAMILY CARE INC.
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 1, 2021
- Last certification
- Mar 31, 2026
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Incorporated
- Feb 1, 2020 in TN
- Enrollment address
- 9458 Highway 100
Scotts Hill, TN 38374-6443
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Penny J Pope |
5% Or Greater Direct Ownership Interest | Feb 1, 2020 | 50% |
| Corporate Officer | Feb 1, 2020 | 50% | |
| W-2 Managing Employee |
Feb 1, 2020 | 50% | |
| Operational/Managerial Control |
Feb 1, 2020 | 50% | |
| Danny Pope |
5% Or Greater Direct Ownership Interest | Feb 1, 2020 | 50% |
| Corporate Officer |
Feb 1, 2020 | 50% | |
| W-2 Managing Employee |
Feb 1, 2020 | 50% | |
| Operational/Managerial Control |
Feb 1, 2020 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200402001492 | TN | Part B Supplier - Clinic/Group Practice | 0840629440 |
Receives reassigned benefits from 6 practitioners Practice locations: Scotts Hill, TN |
| O20200923002573 | TN | Part a Provider - Rural Health Clinic | 0840629440 | Practice locations: Scotts Hill, TN |
National Provider Directory
Locations
9458 Highway 100
Scotts Hill, TN 38374
Phone (731) 549-2600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Rural Health Clinic/Center | 261QR1300X |
Addresses
Primary practice location
9458 Highway 100
Scotts Hill, TN 38374-6443
Mailing address
9458 Highway 100
Scotts Hill, TN 38374-6443
Phone (731) 549-2600
Other providers in Scotts Hill, TN
- Greg Edgin
- Misty Kelley
- Shaunda L. Lewis
- Justin G Morris
- Penny J Pope
- Scotts Hill Discount Drugs,LLC
- Scotts Hill Medical Clinic, Inc
- Linda S Siegl
- The Grove Primary Care Clinic LLC
- Tad Duane Ward
All providers in Scotts Hill, TN · Family Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2021. 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.