NPIMap

Organization Active NPI

Charles H. Wilkens, M.D.,P.C.

  • Rural Health Clinic/Center
  • Jellico, TN
National Provider Identifier
1992841233
Registry record updated Dec 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CHARLES H. WILKENS, M.D.,P.C.
Practice address
131 Hospital LN
Jellico, TN 37762-4404
Phone
(423) 784-7269
NPI assigned
Jan 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2023

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

Authorized official

Name
Christy Timmins
Title
CPC
Phone
(423) 784-0269

Specialties & licenses 1

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

Addresses

Primary practice location

131 Hospital LN
Jellico, TN 37762-4404

Mailing address

PO Box 447
Jellico, TN 37762-0447
Phone (423) 784-7269

Other identifiers 1

IdentifierTypeStateIssuer
35001320MedicaidKY

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050628000034 TN Part A Provider - Rural Health Clinic 8224073432 Practice locations: Jellico, TN
O20080721000468 TN Part B Supplier - Clinic/Group Practice 8224073432 Receives reassigned benefits from 7 practitioners
Practice locations: Jellico, TN

Rural health clinic certification: CCN 443925

Legal name
CHARLES H. WILKENS, M.D.,P.C.
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 19, 1999
Last certification
Apr 12, 2017
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Sep 6, 1977 in TN
Enrollment address
131 Hospital LN
Jellico, TN 37762-4404

National Provider Directory

National Provider Directory

Locations

896 S Highway 25 W
Williamsburg, KY 40769
Phone (606) 376-9700

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24159/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Darryl John Wilkens Individual 5% Or Greater Direct Ownership Interest Dec 21, 2021 33%
Corporate DirectorMedical Director Sep 30, 2015 100%
W-2 Managing Employee Dec 27, 2021
Stephen Boone Individual Corporate OfficerCeo Jan 1, 2013
W-2 Managing EmployeeVice President, Ceo Dec 27, 2021
Todd H. Wilkens Individual 5% Or Greater Direct Ownership Interest Dec 27, 2021 33%
Gregory C. Wilkens Individual 5% Or Greater Direct Ownership Interest Dec 27, 2021 33%

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702598400000",
    "number": "1992841233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 447",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377620447",
            "telephone_number": "423-784-7269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 HOSPITAL LN",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377624404",
            "telephone_number": "423-784-7269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES H. WILKENS, M.D.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A",
        "authorized_official_last_name": "TIMMINS",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "CPC",
        "authorized_official_telephone_number": "423-784-0269"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35001320",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jellico, TN

Sources for this page

Verify at the official NPI Registry.