Pioneer Pediatrics, PLLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

36250 Issued in TN

Legal business name

PIONEER PEDIATRICS, PLLC

Practice address

236 E Main St
McMinnville, TN 37110-2508

Phone

(931) 815-5437

Fax

(931) 507-5440

NPI assigned

Aug 17, 2007

Last updated

Aug 25, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Melinda R Harper, PNPNPI 1225166564

Title

Partner

Phone

(931) 815-5437

Specialties & licenses 4

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184816720. Details of each certification follow.

• CCN 443967 Rural health clinic · Active · Details

Rural health clinic certification: CCN 443967

Legal name

PIONEER PEDIATRICS, PLLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Nov 4, 2008

Last certification

Dec 13, 2021

Ownership / control type

1C

Organization structure

LLCProprietary

Incorporated

Aug 8, 2002 in TN

Enrollment address

236 E Main Street
McMinnville, TN 37110-2508

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 7

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.

• Melinda R Harper, PNP

  • Nurse Practitioner
  • McMinnville, TN
  • NPI 1225166564
  NPD (past) Authorized official
• Michael G. Andrews, D.O.

  • Pediatrics Physician
  • McMinnville, TN
  • NPI 1336183227
  NPD (past)
• Amy Fults, FNP-C

  • Family Nurse Practitioner
  • Smithville, TN
  • NPI 1053864611
  NPD (past)
• Anna Ledbetter, FNP-BC

  • Family Nurse Practitioner
  • McMinnville, TN
  • NPI 1497376552
  NPD (past)
• Jeffrey K McVey, DO

  • Pediatrics Physician
  • McMinnville, TN
  • NPI 1316949969
  NPD (past)
• Amy L Rogers, D.O.

  • Pediatrics Physician
  • McMinnville, TN
  • NPI 1932364049
  NPD (past)
• Leslie Robin Whaley, FNP

  • Family Nurse Practitioner
  • McMinnville, TN
  • NPI 1992042287
  NPD (past)

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

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314230400000",
    "number": "1184816720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "236 E MAIN ST",
            "city": "MCMINNVILLE",
            "state": "TN",
            "postal_code": "371102508",
            "telephone_number": "931-815-5437",
            "fax_number": "931-507-5440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 E MAIN ST",
            "city": "MCMINNVILLE",
            "state": "TN",
            "postal_code": "371102508",
            "telephone_number": "931-815-5437",
            "fax_number": "931-507-5440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIONEER PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-17",
        "last_updated": "2011-08-25",
        "status": "A",
        "authorized_official_last_name": "HARPER",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "931-815-5437",
        "authorized_official_credential": "PNP"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TN",
            "license": "APN0000012370",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "36250",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "1618",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "1768",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3878545",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1134121783",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1225166564",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1316949969",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5440799",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5441183",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1336183227",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5440223",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in McMinnville, TN
• Providers in McMinnville, TN by specialty
• Pediatrics Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.