NPIMap

Organization Active NPI

Brookside Medical Center PLLC

  • Family Medicine Physician
  • Collegedale, TN
National Provider Identifier
1083637078
Registry record updated Nov 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BROOKSIDE MEDICAL CENTER PLLC
Practice address
5121 Ooltewah Ringgold Road
Suite G
Collegedale, TN 37315
Phone
(423) 238-0033
NPI assigned
Jul 25, 2006
Last updated
Nov 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2009

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

Authorized official

Name
Shirley Spears, MS, ANP, BCNPI 1295757391
Title
Administrator
Phone
(423) 238-0033

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
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

5121 Ooltewah Ringgold Road
Suite G
Collegedale, TN 37315

Mailing address

PO Box 793
Ooltewah, TN 37363-0793
Phone (423) 238-0033

Other identifiers 1

IdentifierTypeStateIssuer
3735307MedicaidTN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259539200000",
    "number": "1083637078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 793",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373630793",
            "telephone_number": "423-238-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5121 OOLTEWAH RINGGOLD ROAD",
            "address_2": "SUITE G",
            "city": "COLLEGEDALE",
            "state": "TN",
            "postal_code": "37315",
            "telephone_number": "423-238-0033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSIDE MEDICAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2009-11-30",
        "status": "A",
        "authorized_official_last_name": "SPEARS",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "423-238-0033",
        "authorized_official_credential": "MS, ANP, BC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3735307",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Collegedale, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.