NPIMap

Organization Active NPI

Premier Orthopaedics & Sports Medicine, PLC

  • Durable Medical Equipment & Medical Supplies
  • Dickson, TN
National Provider Identifier
1124554068
Registry record updated Sep 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC
Practice address
111 Highway 70 E Ste 103
Dickson, TN 37055-2080
Phone
(615) 455-1966
Fax
(615) 740-0259
NPI assigned
May 11, 2017
Organization subpart
Yes
Parent organization
PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 19, 2018

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

Authorized official

Name
Amy Benchwick
Title
Director of Credentialing
Phone
(706) 324-6661

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X TN Primary

Addresses

Primary practice location

111 Highway 70 E Ste 103
Dickson, TN 37055-2080

Mailing address

PO Box 370
Fortson, GA 31808-0370
Phone (706) 324-6661

Other identifiers 2

IdentifierTypeStateIssuer
0922510016OtherTNMEDICARE DME
3707844MedicaidTN

Other names 1

  • Hughston Clinic Orthopaedics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040301001152 TN Part B Supplier - Clinic/Group Practice 9032023320 Receives reassigned benefits from 83 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Premier Ortho Sports Med

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537315200000",
    "number": "1124554068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "FORTSON",
            "state": "GA",
            "postal_code": "318080370",
            "telephone_number": "706-324-6661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 HIGHWAY 70 E STE 103",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370552080",
            "telephone_number": "615-455-1966",
            "fax_number": "615-740-0259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC",
        "enumeration_date": "2017-05-11",
        "last_updated": "2018-09-19",
        "status": "A",
        "authorized_official_last_name": "BENCHWICK",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "706-324-6661"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME",
            "identifier": "0922510016",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3707844",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hughston Clinic Orthopaedics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hughston Clinic Orthopaedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dickson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; 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.