NPIMap

Organization Active NPI

Amg Crockett LLC

Doing business as Well-Med Lawrenceburg

  • Family Nurse Practitioner
  • Lawrenceburg, TN
National Provider Identifier
1063802767
Registry record updated Apr 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
AMG CROCKETT LLC
Doing business as
Well-Med Lawrenceburg
Practice address
1908 N Locust Ave
Lawrenceburg, TN 38464-2334
Phone
(931) 244-7600
Fax
(931) 244-7601
NPI assigned
Feb 2, 2015
Last updated
Apr 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2015

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

1908 N Locust Ave
Lawrenceburg, TN 38464-2334

Mailing address

1908 N Locust Ave
Lawrenceburg, TN 38464-2334
Phone (931) 244-7600

Other names 1

  • Well-Med Lawrenceburg 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": "1422835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430179200000",
    "number": "1063802767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1908 N LOCUST AVE",
            "city": "LAWRENCEBURG",
            "state": "TN",
            "postal_code": "384642334",
            "telephone_number": "931-244-7600",
            "fax_number": "931-244-7601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1908 N LOCUST AVE",
            "city": "LAWRENCEBURG",
            "state": "TN",
            "postal_code": "384642334",
            "telephone_number": "931-244-7600",
            "fax_number": "931-244-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG CROCKETT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-02",
        "last_updated": "2015-04-28",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "CASEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "931-766-4574"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Well-Med Lawrenceburg",
            "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 Apr 28, 2015; 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.