NPIMap

Organization Active NPI

Bluesky Housecalls, LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Brentwood, TN
National Provider Identifier
1073986410
Registry record updated Feb 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
BLUESKY HOUSECALLS, LLC
Practice address
109 Westpark Dr
Brentwood, TN 37027-5063
Phone
(615) 340-6840
Fax
(615) 600-4804
NPI assigned
Nov 6, 2015
Last updated
Feb 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2024

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

Authorized official

Name
Jacob Wallstedt
Title
Chief of Business Development
Phone
(615) 340-6840

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X Primary

Addresses

Primary practice location

109 Westpark Dr
Brentwood, TN 37027-5063

Mailing address

PO Box 150979
Brentwood, TN 37027

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160303001434 TN Part B Supplier - Clinic/Group Practice 3476859257 Receives reassigned benefits from 18 practitioners
Practice locations: Brentwood, TN

National Provider Directory

National Provider Directory

Locations

109 Westpark Dr
Brentwood, TN 37027
Phone (615) 340-6840

109 Westpark Dr
Ste 330
Brentwood, TN 37027
Phone (615) 340-6840

1601 17th Ave S
Nashville, TN 37212
Phone (615) 340-6840

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GJGCDA

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1446768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707350400000",
    "number": "1073986410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150979",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "37027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 WESTPARK DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275063",
            "telephone_number": "615-340-6840",
            "fax_number": "615-600-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUESKY HOUSECALLS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-06",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "WALLSTEDT",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "CHIEF OF BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "615-340-6840"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brentwood, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.