| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 883843 | (X3) Date Survey Completed 05/13/2026 |
| Name of Provider or Supplier Dickson Medical Associates Mathis Pediatrics | Street Address, City, State 110 Mathis Drive, Suite 103, Dickson, 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 survey was conducted on 5/13/2026 for a recertification survey. The Rural Health Clinic (RHC) was found to have Standard and Condition level deficiencies for non-compliance with the regulations that govern RHCs. |