NPIMap

Organization Active NPI

Tennessee Valley Internal Medicine, PC

  • Internal Medicine Physician
  • Madison, AL
National Provider Identifier
1174892780
Registry record updated Apr 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
TENNESSEE VALLEY INTERNAL MEDICINE, PC
Practice address
3809 Sullivan St
Suite 7
Madison, AL 35758-2372
Phone
(256) 428-1096
Fax
(256) 428-1097
NPI assigned
Dec 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2012

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

Authorized official

Name
Nicholas A Patellis, MDNPI 1366582835
Title
Physician/Owner
Phone
(256) 509-4010

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
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

3809 Sullivan St
Suite 7
Madison, AL 35758-2372

Mailing address

3809 Sullivan St
Suite 7
Madison, AL 35758-2372
Phone (256) 428-1096

Other identifiers 1

IdentifierTypeStateIssuer
136258MedicaidAL

National Provider Directory

National Provider Directory

Locations

3809 Sullivan St
Ste 7
Madison, AL 35758
Phone (256) 428-1096

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12253/brand/1/csg/1/fhir/r4

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": "1325030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334707200000",
    "number": "1174892780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3809 SULLIVAN ST",
            "address_2": "SUITE 7",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357582372",
            "telephone_number": "256-428-1096",
            "fax_number": "256-428-1097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3809 SULLIVAN ST",
            "address_2": "SUITE 7",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357582372",
            "telephone_number": "256-428-1096",
            "fax_number": "256-428-1097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE VALLEY INTERNAL MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-28",
        "last_updated": "2012-04-18",
        "status": "A",
        "authorized_official_last_name": "PATELLIS",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "256-509-4010",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136258",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2012; 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.