NPIMap

Organization Active NPI

Amg - Hillside, LLC

  • Pediatrics Physician
  • Pulaski, TN
National Provider Identifier
1215210364
Registry record updated Sep 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
DO1829 Issued in TN
Legal business name
AMG - HILLSIDE, LLC
Practice address
202 Hillside Dr
Pulaski, TN 38478-4566
Phone
(931) 363-4543
Fax
(931) 363-4523
NPI assigned
Sep 26, 2011
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Jess Judy
Title
Vice-President
Phone
(615) 372-8500

Other NPIs on the same Medicare enrollment 20

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

Corporate family (same tax ID) 22

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

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TN

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070810000665 TN Part B Supplier - Clinic/Group Practice 9436240017 Receives reassigned benefits from 55 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pulaski, TN; Lynnville, TN; Lewisburg, TN; Lawrenceburg, TN; Ardmore, TN

National Provider Directory

Tax ID family
Amg-Hillside LLC (23 organizations share this tax ID)

Locations

26032 Main St
Ardmore, TN 38449
Phone (931) 427-3020

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X DO1829 TN Primary

Addresses

NPPES NPI Registry

Primary practice location

202 Hillside Dr
Pulaski, TN 38478-4566

Mailing address

PO Box 631
Pulaski, TN 38478-0631
Phone (931) 363-4543

Other names 1

NPPES NPI Registry
  • Kids First Pediatric Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 26, 2011.

{
    "created_epoch": "1316995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316995200000",
    "number": "1215210364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 631",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384780631",
            "telephone_number": "931-363-4543",
            "fax_number": "931-363-4523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 HILLSIDE DR",
            "city": "PULASKI",
            "state": "TN",
            "postal_code": "384784566",
            "telephone_number": "931-363-4543",
            "fax_number": "931-363-4523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG - HILLSIDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-26",
        "last_updated": "2011-09-26",
        "status": "A",
        "authorized_official_last_name": "JUDY",
        "authorized_official_first_name": "JESS",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "615-372-8500"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "DO1829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kids First Pediatric Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pulaski, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; 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.