Individual provider Active NPI

Lauren Elizabeth Ghettie, NP

  • Nurse Practitioner
  • Memphis, TN
National Provider Identifier
1093323461
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
BOON-63OKMA Issued in MS
Practice address
880 Madison Ave
Memphis, TN 38103-3409
Phone
(901) 515-3700
NPI assigned
Jul 21, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 28110 TN
Nurse Practitioner 363L00000X BOON-63OKMA MS Primary

Addresses

Primary practice location

880 Madison Ave
Memphis, TN 38103-3409

Mailing address

3415 Shiloh LN
Southaven, MS 38672-6045
Phone (901) 334-6709

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210719002157 TN Practitioner - Nurse Practitioner 1153724869 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ut Regional One Physicians IncGroup PAC ID 5698993418, 314 clinicians

Practice addresses (Care Compare)

6215 Humphreys Blvd
Suite 201
Memphis, TN 38120-2382
Phone (901) 866-8085

Merit-based Incentive Payment System (MIPS)

Final score
80.97 of 100Reported as group
Quality
64.58
Improvement activities
40
Cost
77.33

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
BOON-63OKMAMSMDNurse Practitioner
28110TNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Regional One Physicians Inc Nurse Practitioner CurrentSince Jul 16, 2021 Accepting new patients
Ut Regional One Physicians Inc CurrentSince Jul 16, 2021 Accepting new patients

Locations

877 Jefferson Ave
Memphis, TN 38103
Phone (901) 448-5893

6215 Humphreys Blvd
Ste 201
Memphis, TN 38120
Phone (901) 866-8085

6555 Quince Rd
Memphis, TN 38119
Phone (901) 515-3150

880 Madison Ave
Memphis, TN 38103
Phone (901) 515-3500

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1595289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1093323461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3415 SHILOH LN",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726045",
            "telephone_number": "901-334-6709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 MADISON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381033409",
            "telephone_number": "901-515-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHETTIE",
        "first_name": "LAUREN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-21",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "28110",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "BOON-63OKMA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.