NPIMap

App of Tennessee Ed, PLLC

Organization Active NPI Emergency Medicine Physician · Maryville, TN

NPI 1003230236 · NPPES record last updated Jan 27, 2023

Key facts

NPI
1003230236
Entity type
Organization (NPI type 2)
Primary specialty
Emergency Medicine Physician 207P00000X
Legal business name
APP OF TENNESSEE ED, PLLC
Practice address
907 E Lamar Alexander Pkwy
Maryville, TN 37804
Phone
(865) 983-7211
NPI assigned
Feb 7, 2014
Organization subpart
No

Authorized official

Name
James Grimes
Title
Cfo
Phone
(615) 551-6611

Practitioners 572

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 572

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in TN, VA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20140506000159 TN Part B Supplier - Clinic/Group Practice 8123251766 Receives reassigned benefits from 513 practitioners
Practice locations: Fayetteville, TN; Tullahoma, TN; Springfield, TN; Powell, TN; Newport, TN; Maryville, TN; Knoxville, TN; Jefferson City, TN…
O20180814002326 VA Part B Supplier - Clinic/Group Practice 8123251766 Receives reassigned benefits from 65 practitioners
Practice locations: Big Stone Gap, VA

National Provider Directory

Locations

1559 Sparta St
McMinnville, TN 37110
Phone (615) 406-9544

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207P00000X Yes
Physical Therapy Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 225200000X
Physician Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 363A00000X
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X

Addresses

Primary practice location

907 E Lamar Alexander Pkwy
Maryville, TN 37804

Mailing address

PO Box 31957
Clarksville, TN 37040-0033

Other practice location 1

2000 Brookside Dr
Kingsport, TN 37660-4627
Phone (423) 857-7000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 27, 2023.

{
    "created_epoch": "1391731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674777600000",
    "number": "1003230236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31957",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370400033",
            "fax_number": "205-313-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 E LAMAR ALEXANDER PKWY",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "37804",
            "telephone_number": "865-983-7211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Brookside Dr",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376604627",
            "country_code": "US",
            "telephone_number": "423-857-7000",
            "fax_number": "629-216-0568",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "APP OF TENNESSEE ED, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-07",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A",
        "authorized_official_last_name": "GRIMES",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "615-551-6611"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, TN

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Sources for this page

Verify at the official NPI Registry.