NPIMap

Organization Active NPI

Specialty Physician Group LLC

  • Cardiovascular Disease Physician
  • Germantown, TN
National Provider Identifier
1174842181
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
SPECIALTY PHYSICIAN GROUP LLC
Practice address
7460 Wolf River Blvd
Germantown, TN 38138-1760
Phone
(901) 763-0200
Fax
(901) 761-4002
NPI assigned
Jun 1, 2010
Last updated
Sep 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Authorized official

Name
Tabatha Perry
Title
Manager, Provider Enrollment
Phone
(901) 478-0954

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Medical Physician Assistant 363AM0700X
Surgical Physician Assistant 363AS0400X
Acute Care Nurse Practitioner 363LA2100X
Family Nurse Practitioner 363LF0000X
Cardiovascular Disease Physician 207RC0000X Primary
Clinical Cardiac Electrophysiology Physician 207RC0001X
Interventional Cardiology Physician 207RI0011X
Pediatric Cardiology Physician 2080P0202X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X

Addresses

Primary practice location

7460 Wolf River Blvd
Germantown, TN 38138-1760

Mailing address

1211 Union Ave Ste 700
Memphis, TN 38104-6600
Phone (901) 478-0954

Other identifiers 3

IdentifierTypeStateIssuer
183763002MedicaidAR
1519260MedicaidTN
4269952OtherTNBCBS TN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS, AR3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100714000297 TN Part B Supplier - Clinic/Group Practice 9537291323 Receives reassigned benefits from 134 practitioners
Practice locations: Germantown, TN; Memphis, TN; Jackson, TN; Dyersburg, TN; Cordova, TN; Brighton, TN
O20100715000079 MS Part B Supplier - Clinic/Group Practice 9537291323 Receives reassigned benefits from 45 practitioners
Practice locations: Corinth, MS; Holly Springs, MS; Olive Branch, MS
O20111214000080 AR Part B Supplier - Clinic/Group Practice 9537291323 Receives reassigned benefits from 3 practitioners
Practice locations: West Memphis, AR

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
44D2006441Specialty Physician Group, LLC7460 Wolf River Blvd, Suite 200, Germantown, TN 38138Certificate of waiverApr 21, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

228 W Tyler Ave
Ste 308
West Memphis, AR 72301
Phone (870) 732-5803

4240 Bethel Rd
Ste 201
Olive Branch, MS 38654

4250 Bethel Rd
Fl 5
Olive Branch, MS 38654
Phone (662) 932-9544

7900 Airways Blvd
Bldg B101
Southaven, MS 38671

57 Germantown Ct
Ste 100
Cordova, TN 38018
Phone (901) 435-8550

640 US Highway 51 Byp E
Ste E
Dyersburg, TN 38024
Phone (731) 285-0250

7205 Wolf River Blvd
Ste 201
Germantown, TN 38138
Phone (901) 507-3100

7460 Wolf River Blvd
#200
Germantown, TN 38138

7460 Wolf River Blvd
Ste 100
Germantown, TN 38138

58 Murray Guard Dr
Jackson, TN 38305
Phone (731) 512-5701

1211 Union Ave
Ste 965
Memphis, TN 38104
Phone (901) 435-8550

1325 Eastmoreland Ave
Ste 365
Memphis, TN 38104
Phone (901) 272-6018

1325 Eastmoreland Ave
Ste 510
Memphis, TN 38104
Phone (901) 516-7055

3950 New Covington Pike
Ste 210
Memphis, TN 38128
Phone (901) 516-5372

3950 New Covington Pike
Ste 280
Memphis, TN 38128
Phone (901) 507-3150

3950 New Covington Pike
Ste 290
Memphis, TN 38128
Phone (901) 261-3500

Practitioners & affiliated clinicians

Practitioners 180

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.

View all 180

NPI Registry JSON

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

{
    "created_epoch": "1275350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758499200000",
    "number": "1174842181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 UNION AVE STE 700",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381046600",
            "telephone_number": "901-478-0954",
            "fax_number": "901-937-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7460 WOLF RIVER BLVD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381381760",
            "telephone_number": "901-763-0200",
            "fax_number": "901-761-4002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY PHYSICIAN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-01",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_title_or_position": "MANAGER, PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "901-478-0954"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "183763002",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1519260",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TN",
            "identifier": "4269952",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; 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.