SOUTHERN HEALTH & WELLNESS CLINIC
NPI 1679246987
Clinic/Center - Primary Care in Humboldt, TN
About Southern Health & Wellness Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTHERN HEALTH & WELLNESS CLINIC (NPI 1679246987) is a healthcare organization registered as a primary care in Humboldt, Tennessee and active in the NPI registry since August 2021. The organization holds a CLIA Certificate of Compliance certificate valid through May 25, 2028 and lists Stephanie Thomas Boling, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Southern Health & Wellness Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by January 31, 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.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Southern Health & Wellness Clinic, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
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 Compliance 44D2241394
Southern Health And Wellness Clinic · Humboldt, TNFrequently 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 Southern Health & Wellness Clinic's NPI number?
The NPI number for Southern Health & Wellness Clinic is 1679246987. It was assigned to this organization in the NPPES registry on August 1, 2021.
Where is Southern Health & Wellness Clinic located?
Southern Health & Wellness Clinic is located at 3519 Chere Carol Rd, Humboldt, TN 38343. The listed phone number is (731) 414-9051.
What is Southern Health & Wellness Clinic's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Southern Health & Wellness Clinic enrolled in Medicare?
Yes. Southern Health & Wellness Clinic is registered in the Medicare PECOS enrollment system.
When is Southern Health & Wellness Clinic's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Tennessee, Clinic/Group Practice) is due for revalidation by January 31, 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.
How many clinicians bill Medicare through Southern Health & Wellness Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Southern Health & Wellness Clinic. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Southern Health & Wellness Clinic hold a CLIA laboratory certificate?
Yes. A Certificate of Compliance (number 44D2241394) is associated with this NPI, valid through May 25, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Southern Health & Wellness Clinic was last updated on August 24, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.
# Southern Health & Wellness Clinic · NPI 1679246987
Primary Care organization in Humboldt, Tennessee. Organization record, active in the CMS NPPES registry since August 1, 2021.
## Identity
- **NPI:** 1679246987 (Entity type: Organization)
- **Enumerated:** August 1, 2021
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Stephanie Boling, OWNER
## Practice location
- **Address:** 3519 CHERE CAROL RD, Humboldt, TN 38343-3638
- **Phone:** (731) 414-9051
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** January 31, 2027 (Non-DME Part B, Tennessee, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 24, 2021
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1679246987) · Data from the CMS NPPES public registry.