NPIMap

Organization Active NPI

Premier Orthopaedics & Sports Medicine, PLC

  • Durable Medical Equipment & Medical Supplies
  • Nashville, TN
National Provider Identifier
1164500088
Registry record updated Aug 17, 2023
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
3443 Dickerson Pike
Suite 190
Nashville, TN 37207-2519
Phone
(615) 869-1580
Fax
(615) 860-1541
NPI assigned
Nov 1, 2006
Organization subpart
Yes
Parent organization
PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Authorized official

Name
Amanda Grace Fromkin
Title
Director of Credentialing
Phone
(706) 494-3071

Specialties & licenses 1

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

Addresses

Primary practice location

3443 Dickerson Pike
Suite 190
Nashville, TN 37207-2519

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
3707844MedicaidTN
0922510004OtherTNMEDICARE DME

Other names 1

  • Hughston Clinic Orthopaedics Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930015265 TN DME Supplier - Physician - Orthopedic/Orthopedic Surgery 9032023320 Practice locations: Nashville, TN

National Provider Directory

National Provider Directory
Tax ID family
Premier Ortho Sports Med10 organizations share this tax ID, including this one
Part of
Premier Ortho Sports Med

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Other NPIs with the same Medicare PAC ID 8

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

Practitioners 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1164500088",
    "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": "3443 DICKERSON PIKE",
            "address_2": "SUITE 190",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372072519",
            "telephone_number": "615-869-1580",
            "fax_number": "615-860-1541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC",
        "enumeration_date": "2006-11-01",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "FROMKIN",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "GRACE",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "706-494-3071"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3707844",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME",
            "identifier": "0922510004",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "N",
            "endpointDescription": "esmd.cioxhealth.com and OID is '2.16.840.1.113883.3.6635.1.1'",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "929 North Point Parkway",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Nashville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; 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.