Individual provider Active NPI

Stephanie Grimes Willer, MD

  • Emergency Medicine Physician
  • Chattanooga, TN
National Provider Identifier
1205465424
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
66269 Issued in TN
Practice address
975 E 3Rd St
Chattanooga, TN 37403-2147
Phone
(423) 778-7628
NPI assigned
Apr 8, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 66269 TN Primary

Addresses

Primary practice location

975 E 3Rd St
Chattanooga, TN 37403-2147

Mailing address

975 E 3Rd St
Chattanooga, TN 37403-2147
Phone (423) 778-7628

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230406002028 TN Practitioner - Emergency Medicine 2264844026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
East Tennessee State University Quillen College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tennessee River Physicians, PLLCGroup PAC ID 8022387349, 65 clinicians

Practice addresses (Care Compare)

1751 Gunbarrel Rd
Chattanooga, TN 37421-7177
Phone (423) 778-8700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
66269TNMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tennessee River Physicians, PLLC Emergency Medicine Current Accepting new patients
Tennessee River Physicians, PLLC Emergency Medicine CurrentSince Feb 20, 2023 Accepting new patients
Tennessee River Physicians, PLLC Emergency Medicine CurrentSince Feb 20, 2023 Accepting new patients

Locations

1751 Gunbarrel Rd
Chattanooga, TN 37421
Phone (423) 680-8000

975 E 3rd St
Chattanooga, TN 37403
Phone (423) 266-1499

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1205465424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 E 3RD ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374032147",
            "telephone_number": "423-778-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 E 3RD ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374032147",
            "telephone_number": "423-778-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLER",
        "first_name": "STEPHANIE",
        "middle_name": "GRIMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-08",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "66269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.