Michella Glenna Douglas, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4234 Issued in TN

Practice address

1400 S Germantown Rd
Germantown, TN 38138-2205

Phone

(901) 759-3100

NPI assigned

Mar 30, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Campbell Clinic, PC

  • Orthopaedic Surgery Physician
  • Germantown, TN
  • NPI 1003835141

  MS, Physician Assistant, TN

  Medicare reassignment Care Compare group NPD
• Baptist Memorial Medical Group Inc

  • Internal Medicine Physician
  • Memphis, TN
  • NPI 1306089206

  TN

  Medicare reassignment NPD
• Campbell Clinic PC

  • Durable Medical Equipment & Medical Supplies
  • Bristol, TN
  • NPI 1104711514
  Care Compare group
• Campbell Clinic PC

  • Durable Medical Equipment & Medical Supplies
  • Memphis, TN
  • NPI 1164317368
  Care Compare group
• Campbell Clinic PC

  • Durable Medical Equipment & Medical Supplies
  • Arlington, TN
  • NPI 1194619734
  Care Compare group
• Campbell Clinic PC

  • Durable Medical Equipment & Medical Supplies
  • Sparta, TN
  • NPI 1245128214
  Care Compare group
• Campbell Clinic PC

  • Durable Medical Equipment & Medical Supplies
  • Bristol, TN
  • NPI 1245199264
  Care Compare group
• Campbell Clinic PC

  • Durable Medical Equipment & Medical Supplies
  • Cookeville, TN
  • NPI 1265326664
  Care Compare group
• Campbell Clinic PC

  • Durable Medical Equipment & Medical Supplies
  • Memphis, TN
  • NPI 1356235782
  Care Compare group
• Campbell Clinic PC

  • Durable Medical Equipment & Medical Supplies
  • Memphis, TN
  • NPI 1407740822
  Care Compare group
• Campbell Clinic PC

  • Durable Medical Equipment & Medical Supplies
  • Crossville, TN
  • NPI 1467346858
  Care Compare group
• Campbell Clinic PC

  • Durable Medical Equipment & Medical Supplies
  • Johnson City, TN
  • NPI 1487549895
  Care Compare group

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Campbell Clinic, PC 229 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75.09 of 100Reported as group

Quality

50.47

Promoting interoperability

99

Improvement activities

40

Cost

67.33

Medicare fee-for-service enrollment

Enrolled in TN, MS2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14704/brand/1/csg/1/fhir/r4
• FHIR API: https://api.platform.athenahealth.com/1366/brand/1/csg/1/fhir/r4
• Direct secure messaging: michella.douglas.1@1366.direct.athenahealth.com

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

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1053949586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S GERMANTOWN RD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382205",
            "telephone_number": "901-759-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S GERMANTOWN RD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382205",
            "telephone_number": "901-759-3100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6025 Walnut Grove Rd Ste 301",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381202123",
            "country_code": "US",
            "telephone_number": "901-226-0456",
            "fax_number": "901-226-0458",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "MICHELLA",
        "middle_name": "GLENNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-30",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "4234",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "4234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09376398",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q069916",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth M. Domico, MS, CCC/A
• Donald J Sullivan MD
• Heather O Donato, M.D.
• Francis Daniel Donovan Jr., MD
• William Dorsey
• Paul Michael Douthitt, M.D.
• James Houston Dove, MD
• Ashley Dowdy, PA-C
• Carlos L Dowell, ATC
• Sarah Downen, OTR/L

• All providers in Germantown, TN
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.