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CUMBERLAND PEDIATRIC ASSOCIATES PC
NPI 1104964576
Clinic/Center - Rural Health in Lebanon, TN

Active since February 01, 2007CLIA Certified · 3 labs
1029 W MAIN ST, SUITE M, LEBANON, TN 37087(615) 453-1252(615) 453-1286 Get Directions Write a Review

NPPES record last updated: July 29, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 29, 2026, Mar 16, 2025 (2 updates tracked since 2025).

About Cumberland Pediatric Associates Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CUMBERLAND PEDIATRIC ASSOCIATES PC (NPI 1104964576) is a healthcare organization registered as a rural health in Lebanon, Tennessee and active in the NPI registry since February 2007. The organization holds 3 active CLIA laboratory certificates, maintains 2 additional practice locations, and lists Charles Andrew Jordan, Physician, as its authorized official.

NPPES Registry Identity

NPI1104964576
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameCUMBERLAND PEDIATRIC ASSOCIATES PC
Location Address1029 W MAIN ST, SUITE MLebanon, TN 37087-3351
Mailing Address1029 W Main St, Suite MLebanon, TN 37087-3351 · (615) 453-1252 · Fax (615) 453-1286
Phone(615) 453-1252
Fax(615) 453-1286
Organization SubpartNo
Authorized OfficialCharles Andrew JordanPhysician · (615) 453-1252
Enumeration DateFebruary 1, 2007
Last NPPES UpdateJuly 29, 20262 updates tracked since enumeration
NPPES CertifiedJuly 29, 2026
✔ NPI 1104964576 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X
1029 W MAIN ST, Lebanon, TN 37087
Open in Google Maps ↗

Secondary Practice Locations 2

Location 1333 McMurry Blvd EHartsville, TN 37074-1215 · Phone (615) 549-7737 · Fax (615) 549-7734
Location 28 New Middleton HwyGordonsville, TN 38563-6603 · Phone (615) 683-4200 · Fax (615) 683-4207

Other Identifiers 1

Medicaid3713897TN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Cumberland Pediatric Associates Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by February 28, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateTennesseeEnrollment IDO20210628001819Part A · Rural Health ClinicDue dateFebruary 28, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 44D0968256

Cumberland Pediatric Associates PLLC · Lebanon, TN
Active · expires Jul 31, 2028
CLIA Number44D0968256
Laboratory TypePhysician Office
Certificate Effective DateAugust 1, 2026
Certificate Expiration DateJuly 31, 2028
Laboratory DirectorCharles Jordan
Laboratory Phone(615) 453-1252
Laboratory LocationCumberland Pediatric Associates PLLC1029 West Main Street, Suite M, Lebanon, TN 37087
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 44D2028529

Cumberland Pediatrics Associates PLLC · Gordonsville, TN
Active · expires Oct 16, 2027
CLIA Number44D2028529
Laboratory TypePhysician Office
Certificate Effective DateOctober 17, 2025
Certificate Expiration DateOctober 16, 2027
Laboratory DirectorDr. Charles A. Jordan
Laboratory Phone(615) 683-4200
Laboratory LocationCumberland Pediatrics Associates PLLC8 New Middleton Highway, Gordonsville, TN 38563
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 44D2245780

Cumberland Pediatric Associates PLLC · Hartsville, TN
Active · expires Dec 15, 2027
CLIA Number44D2245780
Laboratory TypePhysician Office
Certificate Effective DateDecember 16, 2025
Certificate Expiration DateDecember 15, 2027
Laboratory DirectorCharles Jordan
Laboratory Phone(615) 549-7737
Laboratory LocationCumberland Pediatric Associates PLLC333 E Mcmurry Blvd, Hartsville, TN 37074
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. STEPHEN HARMON CLAYCOMB M.D.
Pediatrics
1029 W MAIN ST, SUITE M
LEBANON, TN 37087
Wilson County (615) 453-9492
DR. YVONNE WACLAWA PAWLOWSKI M.D.
Pediatrics
1029 W MAIN ST, SUITE M
LEBANON, TN 37087
Wilson County (615) 453-1252
MADISON KANE BEARS PNP
Nurse Practitioner (Pediatrics)
1029 W MAIN ST
LEBANON, TN 37087
Wilson County (615) 450-1659
MS. MARY K WETSELL PNP
Nurse Practitioner (Pediatrics)
1029 W MAIN ST, SUITE M
LEBANON, TN 37087
Wilson County (615) 453-1252
KIDSCARE CLINIC INC
Clinic/Center (Primary Care)
1029 W MAIN ST, SUITE O
LEBANON, TN 37087
Wilson County (615) 453-1252
DONALD W NUESSLE M.D.
Pediatrics
1029 W MAIN ST, SUITE M
LEBANON, TN 37087
Wilson County (615) 453-1252
MARGARET HADLEY APN
Nurse Practitioner (Pediatrics)
1029 W MAIN ST, SUITE M
LEBANON, TN 37087
Wilson County (615) 453-1252
INTEGRITY REHABILITATION GROUP
Clinic/Center (Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF))
1029 W MAIN ST
LEBANON, TN 37087
Wilson County (615) 466-5200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Cumberland Pediatric Associates PC's NPI number?

The NPI number for Cumberland Pediatric Associates PC is 1104964576. It was assigned to this organization in the NPPES registry on February 1, 2007.

Where is Cumberland Pediatric Associates PC located?

Cumberland Pediatric Associates PC is located at 1029 W Main St Suite M, Lebanon, TN 37087. The listed phone number is (615) 453-1252.

What is Cumberland Pediatric Associates PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

Is Cumberland Pediatric Associates PC enrolled in Medicare?

Yes. Cumberland Pediatric Associates PC is registered in the Medicare PECOS enrollment system.

When is Cumberland Pediatric Associates PC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Part A enrollment for this organization (Tennessee, Rural Health Clinic) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

Does Cumberland Pediatric Associates PC hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Cumberland Pediatric Associates PC accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee and 1 other insurer list Cumberland Pediatric Associates PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Cumberland Pediatric Associates PC was last updated on July 29, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.