NPIMap

Organization Active NPI

Family Medicine West PLLC

  • Family Medicine Physician
  • Knoxville, TN
National Provider Identifier
1083962815
Registry record updated Sep 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD30337 Issued in TN
Legal business name
FAMILY MEDICINE WEST PLLC
Practice address
220 Fort Sanders West Blvd
BLDG 2, Suite 200
Knoxville, TN 37922
Phone
(865) 288-4232
Fax
(865) 288-4231
NPI assigned
Aug 28, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2012

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

Authorized official

Name
Dr. Manisha S Thakur, M.D.NPI 1639152275
Title
Owner
Phone
(865) 288-4232

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X MD30337 TN Primary

Addresses

Primary practice location

220 Fort Sanders West Blvd
BLDG 2, Suite 200
Knoxville, TN 37922

Mailing address

220 Fort Sanders West Blvd
BLDG 2, Suite 200
Knoxville, TN 37922
Phone (865) 288-4232

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121008000403 TN Part B Supplier - Clinic/Group Practice 7618126608 Receives reassigned benefits from 19 practitioners
Practice locations: Knoxville, TN; Wartburg, TN

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2035079Family Medicine West220 Fort Sanders West Blvd BLDG 2 Ste 200, Knoxville, TN 37922Certificate of waiverJan 9, 2028

National Provider Directory

National Provider Directory

Locations

220 Fort Sanders West Blvd
Bldg 2
Knoxville, TN 37922

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1346112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347840000000",
    "number": "1083962815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 FORT SANDERS WEST BLVD",
            "address_2": "BLDG 2, SUITE 200",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "37922",
            "telephone_number": "865-288-4232",
            "fax_number": "865-288-4231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 FORT SANDERS WEST BLVD",
            "address_2": "BLDG 2, SUITE 200",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "37922",
            "telephone_number": "865-288-4232",
            "fax_number": "865-288-4231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE WEST PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-28",
        "last_updated": "2012-09-17",
        "status": "A",
        "authorized_official_last_name": "THAKUR",
        "authorized_official_first_name": "MANISHA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "865-288-4232",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD30337",
            "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 Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.