NPIMap

Organization Active NPI

Saint Thomas Hickman Hospital

Doing business as Ascension Saint Thomas Hickman Medical Clinic

  • Rural Health Clinic/Center
  • Centerville, TN
National Provider Identifier
1992718688
Registry record updated Oct 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAINT THOMAS HICKMAN HOSPITAL
Doing business as
Ascension Saint Thomas Hickman Medical Clinic
Hickman Medical Clinic
Practice address
150 E Swan Street
Centerville, TN 37033
Phone
(931) 729-3091
Fax
(931) 729-0809
NPI assigned
Aug 14, 2006
Last updated
Oct 27, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
SAINT THOMAS HICKMAN HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 27, 2022

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

Authorized official

Name
Lisa R Davis
Title
Cfo
Phone
(615) 284-6845

Specialties & licenses 1

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

Addresses

Primary practice location

150 E Swan Street
Centerville, TN 37033

Mailing address

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

Other names 2

  • Ascension Saint Thomas Hickman Medical Clinic Doing business as
  • Hickman Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030102000017 TN Part A Provider - Rural Health Clinic 7315855368 Practice locations: Centerville, TN
O20040115000449 TN Part B Supplier - Clinic/Group Practice 7315855368 Receives reassigned benefits from 83 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Centerville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992718688. Details of each certification follow.

Rural health clinic certification: CCN 443435

Legal name
SAINT THOMAS HICKMAN HOSPITAL
Doing business as
ASCENSION SAINT THOMAS HICKMAN
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 1, 2003
Last certification
Sep 6, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 30, 1985 in TN
Enrollment address
150 E Swan St
Centerville, TN 37033-1446
Related CCNs
441300

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

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
44D1008934Hickman Medical Clinic-Centerville150 East Swan Street, Centerville, TN 37033Certificate of waiverFeb 2, 2027

National Provider Directory

National Provider Directory
Part of
Saint Thomas Hickman Hospital

Member of 1

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

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 DirectorCfo Oct 31, 2022
Steve Gregory Individual Corporate Director Jan 2, 2003
Kevin Don Campbell Individual W-2 Managing EmployeeDirector Jul 1, 1993 100%
Saint Thomas Hickman Hospital Organization, Centerville, TN Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2000
Other Jan 11, 2000
Saint Thomas Health Organization, Nashville, TN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2000
Ascension Health Organization, Saint Louis, MO Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2000
Lisa Davis Individual Corporate DirectorSystem Cfo Jul 1, 2018 100%

Owners & managing parties with NPI records 4

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

Facilities with the same owner 164

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

View all 164

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.

Practitioners & affiliated clinicians

Practitioners 56

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 56

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666828800000",
    "number": "1992718688",
    "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",
            "fax_number": "615-673-4541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E SWAN STREET",
            "city": "CENTERVILLE",
            "state": "TN",
            "postal_code": "37033",
            "telephone_number": "931-729-3091",
            "fax_number": "931-729-0809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT THOMAS HICKMAN HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAINT THOMAS HICKMAN HOSPITAL",
        "enumeration_date": "2006-08-14",
        "last_updated": "2022-10-27",
        "certification_date": "2020-12-17",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "615-284-6845"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Saint Thomas Hickman Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hickman Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centerville, TN

Sources for this page

Verify at the official NPI Registry.