NPIMap

Organization Active NPI

Momentum Medical Group PC

  • Multi-Specialty Clinic/Center
  • Nashville, TN
National Provider Identifier
1124321062
Registry record updated Apr 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MOMENTUM MEDICAL GROUP PC
Practice address
1910 Church St
2ND Floor (Suite 200)
Nashville, TN 37203-2204
Phone
(615) 208-9010
Fax
(615) 208-9020
NPI assigned
Dec 15, 2010
Last updated
Apr 2, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2014

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

Authorized official

Name
Kent Van Sickle, MDNPI 1629085998
Title
Owner
Phone
(615) 208-9010

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
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

1910 Church St
2ND Floor (Suite 200)
Nashville, TN 37203-2204

Mailing address

PO Box 680245
Franklin, TN 37068-0245
Phone (615) 208-9010

Other identifiers 1

IdentifierTypeStateIssuer
1523117MedicaidTN

National Provider Directory

National Provider Directory

Locations

1910 Church St
Ste 200
Nashville, TN 37203
Phone (615) 208-9010

Practitioners & affiliated clinicians

Practitioners 4

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": "1292371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396396800000",
    "number": "1124321062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 680245",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370680245",
            "telephone_number": "615-208-9010",
            "fax_number": "615-208-9020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 CHURCH ST",
            "address_2": "2ND FLOOR (SUITE 200)",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372032204",
            "telephone_number": "615-208-9010",
            "fax_number": "615-208-9020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMENTUM MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-15",
        "last_updated": "2014-04-02",
        "status": "A",
        "authorized_official_last_name": "VAN SICKLE",
        "authorized_official_first_name": "KENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-208-9010",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1523117",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2014; 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.