NPIMap

Organization Active NPI

State of Tennessee

Doing business as Sumner County Portland Clinic

  • Public Health or Welfare Agency
  • Portland, TN
National Provider Identifier
1003090036
Registry record updated Aug 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
STATE OF TENNESSEE
Doing business as
Sumner County Portland Clinic
Practice address
214 West Longview Drive
Portland, TN 37148
Phone
(615) 325-5237
Fax
(615) 325-5549
NPI assigned
Dec 27, 2007
Last updated
Aug 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Annette Haley
Title
Regional Director
Phone
(615) 650-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X TN Primary

Addresses

Primary practice location

214 West Longview Drive
Portland, TN 37148

Mailing address

214 West Longview Drive
Portland, TN 37148
Phone (615) 325-5237

Other identifiers 1

IdentifierTypeStateIssuer
1511601MedicaidTN

Other names 1

  • Sumner County Portland Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013001259 TN Part B Supplier - Mass Immunization (Roster Biller Only) 5698687077 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Maury Co Healt H Dept202 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

214 W Longview Dr
Portland, TN 37148
Phone (615) 325-5237

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346112000000",
    "number": "1003090036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 WEST LONGVIEW DRIVE",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "37148",
            "telephone_number": "615-325-5237",
            "fax_number": "615-325-5549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 WEST LONGVIEW DRIVE",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "37148",
            "telephone_number": "615-325-5237",
            "fax_number": "615-325-5549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2012-08-28",
        "status": "A",
        "authorized_official_last_name": "HALEY",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR",
        "authorized_official_telephone_number": "615-650-7000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1511601",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sumner County Portland Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.