SIGNATURE HEALTHCARE OF ROGERSVILLE
NPI 1104017490
Nursing Facility/Intermediate Care Facility in Rogersville, TN

NPI Status: Active since August 05, 2007

Contact Information

109 HIGHWAY 70 N
ROGERSVILLE, TN
ZIP 37857
Phone: (423) 272-3099
Fax: (423) 272-6591

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Insurance Plans Accepted
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Nursing Facility/Intermediate Care Facil...
Accepts Insurance
CLIA Number: 44D0659232
CLIA Cert. Type: Skilled Nursing Facility/Nursing Facility
CLIA Exp. Date: 08-31-2026

About SIGNATURE HEALTHCARE OF ROGERSVILLE

This page provides the complete NPI Profile along with additional information for Signature Healthcare Of Rogersville, a provider established in Rogersville, Tennessee operating as a Nursing Facility/intermediate Care Facility. The healthcare provider is registered in the NPI registry with number 1104017490 assigned on August 2007. The practitioner's primary taxonomy code is 313M00000X with license number 124 (TN). The provider is registered as an organization and their NPI record was last updated 3 years ago. The provider's is doing business as Signature Healthcare Of Rogersville. The authorized official of this NPI record is Mr. John Harrison (Cfo)

NPI: 1104017490
Provider Legal Name: LP ROGERSVILLE LLC
Other Organization Name: SIGNATURE HEALTHCARE OF ROGERSVILLE
Other Name Type: Doing Business As (3)
Entity Type: Organization
Location Address: 109 HIGHWAY 70 N ROGERSVILLE, TN 37857
Location Phone: (423) 272-3099
Location Fax: (423) 272-6591
Mailing Address: 12201 BLUEGRASS PARKWAY LOUISVILLE, KY 40299
Mailing Phone: (502) 568-7800
Mailing Fax: (423) 272-6591
Is Sole Proprietor?: No
Is Organization Subpart?: Yes
Enumeration Date: 08-05-2007
Last Update Date: 04-04-2023
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Nursing Facility/Intermediate Care Facility
Taxonomy Code: 313M00000X
Type: Nursing & Custodial Care Facilities
License No.: 124
License State: TN
Taxonomy Description: An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No.	Taxonomy Code	Type	Classification / Specialization	License No. (State)
1	314000000X	Nursing & Custodial Care Facilities	Skilled Nursing Facility	124 (TN)

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Ambetter from Arkansas Health & Wellness

Choice Bronze HSA (QualChoice) - POS
Complete Gold - PPO
Complete Gold + Vision + Adult Dental - PPO
Connected Silver - PPO
Connected Silver (QualChoice) - POS
Connected Silver (QualChoice) + Vision + Adult Dental - POS
Connected Silver (QualChoiceLife) - PPO
Connected Silver (QualChoiceLife) + Vision + Adult Dental - PPO
Connected Silver + Vision + Adult Dental - PPO
Elite Bronze - PPO
Elite Bronze + Vision + Adult Dental - PPO
Elite Gold (QualChoice) - POS
Elite Gold (QualChoice) + Vision + Adult Dental - POS
Elite Gold (QualChoiceLife) - PPO
Elite Gold (QualChoiceLife) + Vision + Adult Dental - PPO
Everyday Bronze - PPO
Everyday Bronze + Vision + Adult Dental - PPO
Standard Expanded Bronze - PPO
Standard Expanded Bronze (QualChoice) - POS
Standard Expanded Bronze + Vision + Adult Dental - PPO

Ambetter from Home State Health

Complete Gold - EPO
Complete Gold + Vision + Adult Dental - EPO
Complete Silver - EPO
Complete Silver + Vision + Adult Dental - EPO
Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO
Everyday Gold - EPO
Everyday Gold + Vision + Adult Dental - EPO
Standard Expanded Bronze - EPO
Standard Expanded Bronze + Vision + Adult Dental - EPO
Standard Gold - EPO
Standard Gold + Vision + Adult Dental - EPO
Standard Silver - EPO
Standard Silver + Vision + Adult Dental - EPO

Ambetter from Magnolia Health

Choice Bronze HSA - HMO
Choice Bronze HSA + Vision + Adult Dental - HMO
Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Everyday Bronze - HMO
Everyday Bronze + Vision + Adult Dental - HMO
Everyday Gold - HMO
Everyday Gold + Vision + Adult Dental - HMO
Standard Expanded Bronze - HMO
Standard Expanded Bronze + Vision + Adult Dental - HMO
Standard Gold - HMO
Standard Gold + Vision + Adult Dental - HMO
Standard Silver - HMO
Standard Silver + Vision + Adult Dental - HMO

Ambetter of Alabama

Complete Gold - EPO
Complete Gold + Vision + Adult Dental - EPO
Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Elite Gold - EPO
Elite Gold + Vision + Adult Dental - EPO
Enhanced Diabetes Care Silver with $0 Drug Options - EPO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO
Focused Silver - EPO
Focused Silver + Vision + Adult Dental - EPO
Standard Expanded Bronze - EPO
Standard Expanded Bronze + Vision + Adult Dental - EPO
Standard Gold - EPO
Standard Gold + Vision + Adult Dental - EPO
Standard Silver - EPO
Standard Silver + Vision + Adult Dental - EPO

Ambetter of North Carolina

Clear Silver with $0 Insulin Options - HMO
Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Complete Gold with Atrium Health - HMO
Complete Gold with Atrium Health + Vision + Adult Dental - HMO
Elite Bronze - HMO
Elite Bronze + Vision + Adult Dental - HMO
Elite Bronze with Atrium Health - HMO
Elite Bronze with Atrium Health + Vision + Adult Dental - HMO
Enhanced Asthma/COPD Care Silver with $0 Drug Options - HMO
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental - HMO
Everyday Bronze - HMO
Everyday Bronze + Vision + Adult Dental - HMO
Everyday Bronze with Atrium Health - HMO
Everyday Bronze with Atrium Health + Vision + Adult Dental - HMO
Focused Silver with Atrium Health - HMO
Focused Silver with Atrium Health + Vision + Adult Dental - HMO
Standard Expanded Bronze - HMO
Standard Expanded Bronze + Vision + Adult Dental - HMO
Standard Expanded Bronze with Atrium Health - HMO

Ambetter of Tennessee

Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Elite Gold - EPO
Elite Gold + Vision + Adult Dental - EPO
Enhanced Diabetes Care Silver with $0 Drug Options - EPO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO
Everyday Gold - EPO
Everyday Gold + Vision + Adult Dental - EPO
Standard Expanded Bronze - EPO
Standard Expanded Bronze + Vision + Adult Dental - EPO
Standard Gold - EPO
Standard Gold + Vision + Adult Dental - EPO
Standard Silver - EPO
Standard Silver + Vision + Adult Dental - EPO

BlueCross BlueShield of Tennessee

BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health� - EPO
BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � - EPO
BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health� - EPO

UnitedHealthcare

UHC Bronze Copay Focus (Virtual Urgent Care, No Referrals) - EPO
UHC Bronze Copay Focus + (Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
UHC Bronze Essential (No Referrals) - EPO
UHC Bronze Standard (No Referrals) - EPO
UHC Gold Advantage (Virtual Urgent Care, No Referrals) - EPO
UHC Gold Advantage + (Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
UHC Gold Copay Focus (Virtual Urgent Care, No Referrals) - EPO
UHC Gold Standard (No Referrals) - EPO
UHC Silver Advantage (Virtual Urgent Care, No Referrals) - EPO
UHC Silver Advantage + (Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
UHC Silver Copay Focus (Virtual Urgent Care, No Referrals) - EPO
UHC Silver Standard (No Referrals) - EPO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: MR. JOHN HARRISON
Authorized Official Title: CFO
Authorized Official Phone: (502) 568-7800

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
7440320	MEDICAID (05)	TN
0445359	MEDICAID (05)	TN

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 44D0659232
Facility Type: Skilled Nursing Facility/Nursing Facility
Certificate Effective Date: September 01, 2024
Certificate Expiration Date: August 31, 2026
Laboratory Director: BARBARA CLARK
Certificate Type: Certificate of Waiver
Certificate Type Description: This CLIA certificate is issued to Signature Healthcare Of Rogersville to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1104017490, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 50. The final step is to find the difference between that total and the next multiple of ten (50 - 50 = 0).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 0

Pos 4

Unchanged

Pos 5

Doubled → 0

Pos 6

Unchanged

Pos 7

Doubled → 14 → 1 + 4

Pos 8

Unchanged

Pos 9

Doubled → 18 → 1 + 8

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 0 → 0 0 → 0 7 → 14 → 5 9 → 18 → 9

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 1 + 0 + 4 + 0 + 1 + 1 + 4 + 4 + 1 + 8 + 24 = 50

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 50 is 50. The difference is the calculated check digit.

50 - 50 = 0

This NPI is valid

The calculated check digit is 0, which matches the last digit of 1104017490.