NPIMap

Organization Active NPI

Southeastern Swallowing Diagnostics

  • Health Service Clinic/Center
  • Ooltewah, TN
National Provider Identifier
1205377348
Registry record updated Oct 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
SOUTHEASTERN SWALLOWING DIAGNOSTICS
Practice address
8459 Lexie LN
Ooltewah, TN 37363-5796
Phone
(301) 275-4057
NPI assigned
Mar 8, 2017
Last updated
Oct 3, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2018

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

Authorized official

Name
Kayla Stout
Title
Co-Owner/Therapist
Phone
(229) 318-9594

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

8459 Lexie LN
Ooltewah, TN 37363-5796

Mailing address

8459 Lexie LN
Ooltewah, TN 37363-5796
Phone (301) 275-4057

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181010001770 TN Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7719239359 Receives reassigned benefits from 2 practitioners
Practice locations: Chattanooga, TN
O20181031000891 GA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7719239359 Receives reassigned benefits from 37 practitioners
Practice locations: Lookout Mountain, GA; Smyrna, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 42

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 42

NPI Registry JSON

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

{
    "created_epoch": "1488931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538524800000",
    "number": "1205377348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8459 LEXIE LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373635796",
            "telephone_number": "301-275-4057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8459 LEXIE LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373635796",
            "telephone_number": "301-275-4057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN SWALLOWING DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-08",
        "last_updated": "2018-10-03",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "KAYLA",
        "authorized_official_title_or_position": "CO-OWNER/THERAPIST",
        "authorized_official_telephone_number": "229-318-9594"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ooltewah, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.