Saint Thomas Hickman Hospital
Organization Active NPI Rural Health Clinic/Center · Centerville, TN
NPI 1992718688 · NPPES record last updated Oct 27, 2022
Key facts
- NPI
- 1992718688
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SAINT THOMAS HICKMAN HOSPITAL
- Practice address
- 150 E Swan Street
Centerville, TN 37033 - Phone
- (931) 729-3091
- Fax
- (931) 729-0809
- NPI assigned
- Aug 14, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- SAINT THOMAS HICKMAN HOSPITAL
Authorized official
- Name
- Lisa R Davis
- Title
- Cfo
- Phone
- (615) 284-6845
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 4
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Member of 1
Related certifications (CCN) 1
Facilities with the same owner 164
Practitioners 63
-
Bretteny Lacole Boyd, MSN, APRN, FNP-C
-
Samantha Lea Claud, FNP-BC
-
Jennifer L Gartman, PA-C
-
Dawn A Glenn, NP
-
Zachary McVey Hutchens, M.D.
-
Rhonda Jane Marcum, APRN, FNP-BC
-
Leigh Ann McInnis, PH.D
-
Loretta Pentlicki, APRN, PMHNP
-
Danielle Smith, APRN
-
Courtney Yocum, LCSW
-
Lauren Hay, PA-C
-
Muhammad Mirza, MBBS
-
Srikar S Reddy, MD
-
Monam Bashir Awan, M.D.
-
John Boileau, FNP-C
-
Victoria Campbell Chester, FNP-BC
-
Meredith Anne Copley, FNP-C
-
Mark Hartsfield, DO
-
Miles Hartsfield, DO
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D1008934 | Hickman Medical Clinic-Centerville | Certificate of waiver | Feb 2, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
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
- Corporation · Non-profit
- Incorporated
- Dec 30, 1985 in TN
- Enrollment address
- 150 E Swan St
Centerville, TN 37033-1446 - Related CCNs
- 441300
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Brandon Williams |
Corporate Director |
Oct 31, 2022 | |
| Steve Gregory |
Corporate Director | Jan 2, 2003 | |
| Kevin Don Campbell |
W-2 Managing Employee |
Jul 1, 1993 | 100% |
| Saint Thomas Hickman Hospital |
5% Or Greater Direct Ownership Interest | Jan 1, 2000 | |
| Other | Jan 11, 2000 | ||
| Saint Thomas Health |
5% Or Greater Direct Ownership Interest | Jan 1, 2000 | |
| Ascension Health |
5% Or Greater Direct Ownership Interest | Jan 1, 2000 | |
| Lisa Davis |
Corporate Director |
Jul 1, 2018 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Baptist Hickman Community
Locations
150 E Swan St
Centerville, TN 37033
Phone (931) 729-3091
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4037834 | Other | TN | BCBS PROF |
| 4057064 | Other | TN | BLUE CROSS BLUE SHIELD |
| 0443435 | Medicaid | TN | |
| 3280569 | Other | TN | MEDICARE PTAN |
Other names
- Ascension Saint Thomas Hickman Medical Clinic
- Hickman Medical Clinic
Other providers in Centerville, TN
- Robert Wilson, DC, PLLC
- Andy Allen Ross
- Saint Thomas Health
- Saint Thomas Hickman Hospital
- Saint Thomas Hickman Hospital
- Saint Thomas Home Health
- Cynthia Sarlo
- Anup K. Satpathy
- John Thomas Sexton
- Danielle Smith
All providers in Centerville, TN · Rural Health Clinic/Center 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 27, 2022. 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.