Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 883828 (X3) Date Survey Completed 11/25/2025
Name of Provider or Supplier Anew Family Medical Pllc Street Address, City, State 111 Front Street, Henderson, TN
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
J0000 An unannounced recertification survey was completed on 9/23/2025 for the Conditions for Coverage for Rural Health Clinics. The entrance conerence was held at 11:00 AM with the OM. The purpose of the visit was explained, and a list of request was provided. An exit conference was held on 9/23/2025, at 3:00 PM with the OM. Deficiencies were cited under 42 CFR 491, Subpart A -Conditions of Participation for Rural Health Clinic. Condition level deficiency was cited under 491.11 Program Evaluation. Exit date amended to 11/25/25 per CMS guidance following federal government shutdown.