NPIMap

Organization Active NPI

Belmont Behavioral Health, LLC

  • Psychiatric/Mental Health Registered Nurse
  • Clarksville, TN
National Provider Identifier
1053883538
Registry record updated Dec 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X
Legal business name
BELMONT BEHAVIORAL HEALTH, LLC
Practice address
103 Jefferson St Ste 100
Clarksville, TN 37040-8681
Phone
(931) 221-2881
Fax
(866) 886-8183
NPI assigned
Dec 21, 2018
Last updated
Dec 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2018

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

Authorized official

Name
Mrs. Candise Shantae Belmont, APRNNPI 1760878474
Title
Owner
Phone
(931) 221-2881

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X Primary

Addresses

Primary practice location

103 Jefferson St Ste 100
Clarksville, TN 37040-8681

Mailing address

2250 Wilma Rudolph Blvd # F247
Clarksville, TN 37040-8452

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190503002041 TN Part B Supplier - Clinic/Group Practice 7517209968 Receives reassigned benefits from 6 practitioners
Practice locations: Clarksville, TN

National Provider Directory

National Provider Directory

Locations

103 Jefferson St
Ste 100
Clarksville, TN 37040
Phone (931) 221-2881

2250 Wilma Rudolph Blvd
#F247
Clarksville, TN 37040

Practitioners & affiliated clinicians

Practitioners 8

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": "1545350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545350400000",
    "number": "1053883538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 WILMA RUDOLPH BLVD # F247",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370408452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 JEFFERSON ST STE 100",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370408681",
            "telephone_number": "931-221-2881",
            "fax_number": "866-886-8183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELMONT BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-21",
        "last_updated": "2018-12-21",
        "status": "A",
        "authorized_official_last_name": "BELMONT",
        "authorized_official_first_name": "CANDISE",
        "authorized_official_middle_name": "SHANTAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-221-2881",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; 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.