NPIMap

Organization Active NPI

Orange Grove Center, Inc.

Doing business as Orange Grove Center Primary Health Care Services

  • Adult Medicine Physician
  • Chattanooga, TN
National Provider Identifier
1073668653
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
26723 Issued in TN
Legal business name
ORANGE GROVE CENTER, INC.
Doing business as
Orange Grove Center Primary Health Care Services
Practice address
615 Derby St
Chattanooga, TN 37404-1632
Phone
(423) 493-2905
Fax
(423) 493-2950
NPI assigned
Jan 24, 2007
Last updated
Mar 4, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ORANGE GROVE CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Authorized official

Name
Ms. Tera Roberts
Title
Ceo
Phone
(423) 493-2910

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 8686 TN
Adult Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QA0505X 26723 TN Primary
Primary Care Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP2300X 13774 TN

Addresses

Primary practice location

615 Derby St
Chattanooga, TN 37404-1632

Mailing address

615 Derby St
Attention: Health Informatics & Reimbursement
Chattanooga, TN 37404-1632
Phone (423) 493-2906

Other identifiers 3

IdentifierTypeStateIssuer
CH3763OtherTNRR MEDICARE
3070512OtherTNBCBS ID
3399927MedicaidTN

Other names 1

  • Orange Grove Center Primary Health Care Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031223000480 TN Part B Supplier - Clinic/Group Practice 1850299124 Receives reassigned benefits from 3 practitioners
Practice locations: Chattanooga, TN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Health Habilitation SRV22 organizations share this tax ID, including this one
Part of
Health Habilitation SRV

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Practitioners & affiliated clinicians

Practitioners 11

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": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1073668653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 DERBY ST",
            "address_2": "ATTENTION: HEALTH INFORMATICS & REIMBURSEMENT",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374041632",
            "telephone_number": "423-493-2906",
            "fax_number": "423-493-2950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 DERBY ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374041632",
            "telephone_number": "423-493-2905",
            "fax_number": "423-493-2950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORANGE GROVE CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ORANGE GROVE CENTER, INC.",
        "enumeration_date": "2007-01-24",
        "last_updated": "2024-03-04",
        "certification_date": "2024-02-22",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "TERA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "423-493-2910",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "8686",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "TN",
            "license": "26723",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TN",
            "license": "13774",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CH3763",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID",
            "identifier": "3070512",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3399927",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orange Grove Center Primary Health Care Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; 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.