NPIMap

Organization Active NPI

Fort Sanders Obstetrical and Gynecological Group, P.C.

  • Obstetrics & Gynecology Physician
  • Knoxville, TN
National Provider Identifier
1063525236
Registry record updated Jun 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
FORT SANDERS OBSTETRICAL AND GYNECOLOGICAL GROUP, P.C.
Practice address
501 19TH Street
Suite 509
Knoxville, TN 37916-1853
Phone
(865) 524-3208
Fax
(865) 522-4322
NPI assigned
Aug 15, 2006
Last updated
Jun 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2010

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

Authorized official

Name
Dr. Roy C. Broady, M.D.NPI 1033130018
Title
President
Phone
(865) 524-3208

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

501 19TH Street
Suite 509
Knoxville, TN 37916-1853

Mailing address

501 19TH Street
Suite 509
Knoxville, TN 37916-1853
Phone (865) 524-3208

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080311000209 TN Part B Supplier - Clinic/Group Practice 1254416506 Receives reassigned benefits from 12 practitioners
Practice locations: Knoxville, TN

National Provider Directory

National Provider Directory

Locations

501 19th St
Ste 509
Knoxville, TN 37916
Phone (423) 524-1024

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276646400000",
    "number": "1063525236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 19TH STREET",
            "address_2": "SUITE 509",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379161853",
            "telephone_number": "865-524-3208",
            "fax_number": "865-522-4322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 19TH STREET",
            "address_2": "SUITE 509",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379161853",
            "telephone_number": "865-524-3208",
            "fax_number": "865-522-4322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT SANDERS OBSTETRICAL AND GYNECOLOGICAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2010-06-16",
        "status": "A",
        "authorized_official_last_name": "BROADY",
        "authorized_official_first_name": "ROY",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "865-524-3208",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; 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.