Main Adawy
Individual provider Active NPI Family Nurse Practitioner · Arlington, TN
NPI 1063220036 · NPPES record last updated Dec 23, 2024
Key facts
- NPI
- 1063220036
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 36705 (TN)
- Practice address
- 5389 Airline Rd
Arlington, TN 38002-4266 - Phone
- (901) 209-4978
- NPI assigned
- Dec 23, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 19
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Impact Physician Group LLC
Fast Pace Medical Clinic PLLC
Practice addresses (Care Compare)
1240 S Germantown Rd
Germantown, TN 38138-2226
Phone (678) 967-5599
2747 Kirby Rd
Memphis, TN 38119-8236
Phone (931) 253-1110
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250521003323 | TN | Practitioner - Nurse Practitioner | 2668991753 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upperline Healthcare, PC | Current |
Accepting new patients | |
| Impact Physician Group, LLC | Current |
Accepting new patients | |
| Upperline Healthcare, PC | Current |
Accepting new patients | |
| Fast Pace Medical Clinic PLLC | Current |
Accepting new patients | |
| Impact Physician Group, Tennessee LLC | Family | Current |
Accepting new patients |
| Fast Pace Medical Clinic PLLC | Current |
Accepting new patients |
Locations
7348 E Brainerd Rd
Chattanooga, TN 37421
Phone (205) 822-8038
108 Courtright Rd
Martin, TN 38237
Phone (731) 281-4183
2747 Kirby Rd
Memphis, TN 38119
Phone (901) 203-0750
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JFDJDD/Endpoint/JFDJDD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 36705 | TN | Yes |
Addresses
Primary practice location
5389 Airline Rd
Arlington, TN 38002-4266
Mailing address
485 Ensworth CT Apt 302
Cordova, TN 38018-2220
Phone (901) 605-6959
Other providers in Arlington, TN
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- Accent ADHD Support Services, LLC
- Lisa Ann Adams
- Benjamin W Addison
- Advocate Healthcare
- Affordable Dentures & Implants - Tennessee, PLLC
- Agilitas USA, Inc
- Zeineba Ahmed
All providers in Arlington, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.