NPIMap

Organization Active NPI

Amg Crockett LLC

Doing business as Southern Tennessee Heart

  • Cardiovascular Disease Physician
  • Lawrenceburg, TN
National Provider Identifier
1013374073
Registry record updated Jan 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
AMG CROCKETT LLC
Doing business as
Southern Tennessee Heart
Practice address
1611 S Locust Ave
Suite 200B
Lawrenceburg, TN 38464-4055
Phone
(931) 766-3684
NPI assigned
Jan 21, 2016
Last updated
Jan 21, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2016

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

Authorized official

Name
Casey J. Willis
Title
Market Manager
Phone
(931) 766-4574

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

1611 S Locust Ave
Suite 200B
Lawrenceburg, TN 38464-4055

Mailing address

1611 S Locust Ave
Suite 200B
Lawrenceburg, TN 38464-4055
Phone (931) 766-3684

Other names 1

  • SOUTHERN TENNESSEE HEART Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071017000313 TN Part B Supplier - Clinic/Group Practice 4789770199 Receives reassigned benefits from 92 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lawrenceburg, TN; Winchester, TN; Pulaski, TN; Mt Pleasant, TN; Loretto, TN; Decherd, TN

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1453334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453334400000",
    "number": "1013374073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 S LOCUST AVE",
            "address_2": "SUITE 200B",
            "city": "LAWRENCEBURG",
            "state": "TN",
            "postal_code": "384644055",
            "telephone_number": "931-766-3684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 S LOCUST AVE",
            "address_2": "SUITE 200B",
            "city": "LAWRENCEBURG",
            "state": "TN",
            "postal_code": "384644055",
            "telephone_number": "931-766-3684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG CROCKETT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-21",
        "last_updated": "2016-01-21",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "CASEY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "MARKET MANAGER",
        "authorized_official_telephone_number": "931-766-4574"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHERN TENNESSEE HEART",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrenceburg, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; 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.