NPIMap

Organization Active NPI

Hometown Urgent Care of Dyersburg PLLC

  • Urgent Care Clinic/Center
  • Dyersburg, TN
National Provider Identifier
1003318593
Registry record updated May 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
HOMETOWN URGENT CARE OF DYERSBURG PLLC
Practice address
2550 Parr Ave
Dyersburg, TN 38024
Phone
(731) 325-5678
NPI assigned
Mar 1, 2018
Last updated
May 25, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2018

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

Authorized official

Name
Mohsin Alhaddad, MDNPI 1467624619
Title
Provider
Phone
(731) 325-5678

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

2550 Parr Ave
Dyersburg, TN 38024

Mailing address

2550 Parr Ave
Dyersburg, TN 38024-2033
Phone (731) 325-5678

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180924003434 TN Part B Supplier - Clinic/Group Practice 8820349202 Receives reassigned benefits from 24 practitioners
Practice locations: Dyersburg, TN
O20200610002833 MO Part B Supplier - Clinic/Group Practice 8820349202 Receives reassigned benefits from 1 practitioner
Practice locations: Hayti, MO; Kennett, MO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2133677Hometown Urgent Care of Dyersburg, PLLC2550 Parr Avenue, Dyersburg, TN 38024Certificate of waiverApr 5, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527206400000",
    "number": "1003318593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 PARR AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380242033",
            "telephone_number": "731-325-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 PARR AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "38024",
            "telephone_number": "731-325-5678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMETOWN URGENT CARE OF DYERSBURG PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-01",
        "last_updated": "2018-05-25",
        "status": "A",
        "authorized_official_last_name": "ALHADDAD",
        "authorized_official_first_name": "MOHSIN",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "731-325-5678",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dyersburg, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.