NPIMap

Organization Active NPI

East Tennessee Children's Primary Care Center, Inc.

Doing business as Dolly Parton Children's Hospital Maryville Pediatrics

  • Pediatrics Physician
  • Alcoa, TN
National Provider Identifier
1184829368
Registry record updated Sep 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
EAST TENNESSEE CHILDREN'S PRIMARY CARE CENTER, INC.
Doing business as
Dolly Parton Children's Hospital Maryville Pediatrics
Maryville Pediatrics
Practice address
352 Fountain View Cir
Alcoa, TN 37701-1945
Phone
(865) 982-0032
Fax
(866) 307-8963
NPI assigned
Jun 18, 2007
Last updated
Sep 5, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST TENNESSEE CHILDREN'S PRIMARY CARE CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 5, 2026

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

Authorized official

Name
Andrew Rosendahl
Title
Chief Financial Officer
Phone
(865) 541-8154

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU
Family Nurse Practitioner 363LF0000X NU
Pediatric Nurse Practitioner 363LP0200X NU
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

352 Fountain View Cir
Alcoa, TN 37701-1945

Mailing address

PO Box 50068
Knoxville, TN 37950-0068
Phone (865) 541-8895

Other identifiers 1

IdentifierTypeStateIssuer
5441765MedicaidTN

Other names 2

  • Dolly Parton Children's Hospital Maryville Pediatrics Doing business as
  • Maryville Pediatrics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190411002554 TN Part B Supplier - Clinic/Group Practice 2961783626 Receives reassigned benefits from 5 practitioners
4 other NPIs on this enrollment
Practice locations: Knoxville, TN; Vonore, TN; Seymour, TN; Sevierville, TN; Oak Ridge, TN; Maryville, TN; La Follette, TN; Greeneville, TN…

Other NPIs on the same Medicare enrollment 2

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

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
44D0678339East Tennessee Children's Hospital Primary Care352 Fountain View Circle, Alcoa, TN 37701ComplianceApr 13, 2028

National Provider Directory

National Provider Directory
Tax ID family
East Tennessee Children's Primary Care Center Inc14 organizations share this tax ID, including this one
Part of
East Tennessee Children's Primary Care Center Inc

Other organizations with this tax ID 13

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

View all 13

Locations

125 Mountain View Dr
Ste 300
Vonore, TN 37885
Phone (423) 884-2170

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788566400000",
    "number": "1184829368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50068",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379500068",
            "telephone_number": "865-541-8895",
            "fax_number": "865-633-4808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "352 FOUNTAIN VIEW CIR",
            "city": "ALCOA",
            "state": "TN",
            "postal_code": "377011945",
            "telephone_number": "865-982-0032",
            "fax_number": "866-307-8963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE CHILDREN'S PRIMARY CARE CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST TENNESSEE CHILDREN'S PRIMARY CARE CENTER, INC.",
        "enumeration_date": "2007-06-18",
        "last_updated": "2026-09-05",
        "certification_date": "2026-09-05",
        "status": "A",
        "authorized_official_last_name": "ROSENDAHL",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "865-541-8154"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5441765",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dolly Parton Children's Hospital Maryville Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maryville Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alcoa, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2026; 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.