NPIMap

Organization Active NPI

Community Quick Care of Lavergne, PC

  • Family Medicine Physician
  • La Vergne, TN
National Provider Identifier
1194023366
Registry record updated Jun 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
339630 Issued in TN
Legal business name
COMMUNITY QUICK CARE OF LAVERGNE, PC
Practice address
5148A Murfreesboro Rd
La Vergne, TN 37086-2712
Phone
(615) 213-1203
Fax
(615) 527-0270
NPI assigned
Mar 11, 2011
Last updated
Jun 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2012

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

Authorized official

Name
Jerry P. EledgeNPI 1639299027
Title
Ceo
Phone
(615) 943-5072

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 339630 TN Primary
Urgent Care Clinic/Center 261QU0200X 339630 TN

Addresses

Primary practice location

5148A Murfreesboro Rd
La Vergne, TN 37086-2712

Mailing address

PO Box 2684
Brentwood, TN 37024-2684
Phone (615) 943-5072

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110520000260 TN Part B Supplier - Clinic/Group Practice 2466638705 Receives reassigned benefits from 27 practitioners
Practice locations: La Vergne, TN

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
44D2023515Community Quick Care5148A Murfreesboro Rd, La Vergne, TN 37086Certificate of waiverApr 25, 2027

National Provider Directory

National Provider Directory

Locations

2545 Murfreesboro Pike
Nashville, TN 37217
Phone (615) 641-2273

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1299801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338854400000",
    "number": "1194023366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2684",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370242684",
            "telephone_number": "615-943-5072",
            "fax_number": "615-527-0270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5148A MURFREESBORO RD",
            "city": "LA VERGNE",
            "state": "TN",
            "postal_code": "370862712",
            "telephone_number": "615-213-1203",
            "fax_number": "615-527-0270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY QUICK CARE OF LAVERGNE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-11",
        "last_updated": "2012-06-05",
        "status": "A",
        "authorized_official_last_name": "ELEDGE",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-943-5072"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "339630",
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "TN",
            "license": "339630",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Vergne, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2012; 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.