NPIMap

Organization Active NPI

Summit Medical Group PLLC

Doing business as Hometown Pediatric Jefferson City

  • Pediatrics Physician
  • Jefferson City, TN
National Provider Identifier
1225835754
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SUMMIT MEDICAL GROUP PLLC
Doing business as
Hometown Pediatric Jefferson City
Practice address
123 Mossy Creek Drive
Jefferson City, TN 37760-2410
Phone
(865) 475-5377
NPI assigned
Mar 3, 2025
Last updated
Mar 27, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SUMMIT MEDICAL GROUP PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

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

Authorized official

Name
Sandra Dee Bowles
Title
Provider Enrollment Coordinator
Phone
(865) 584-4747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

123 Mossy Creek Drive
Jefferson City, TN 37760-2410

Mailing address

1275 Dick Lonas Rd Unit 101
Knoxville, TN 37909-1383
Phone (865) 584-4747

Other names 1

  • Hometown Pediatric Jefferson City Doing business as

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
44D0967781Hometown Pediatric Jefferson City123 Mossy Creek Dr, Jefferson City, TN 37760AccreditationMar 22, 2028

National Provider Directory

National Provider Directory
Tax ID family
Dr's Passarello Ferguson64 organizations share this tax ID, including this one
Part of
Dr's Passarello Ferguson

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

123 Mossy Creek Dr
Jefferson City, TN 37760
Phone (865) 475-5377

Practitioners & affiliated clinicians

Practitioners 4

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": "1740960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743033600000",
    "number": "1225835754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 DICK LONAS RD UNIT 101",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379091383",
            "telephone_number": "865-584-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 MOSSY CREEK DRIVE",
            "city": "JEFFERSON CITY",
            "state": "TN",
            "postal_code": "377602410",
            "telephone_number": "865-475-5377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT MEDICAL GROUP PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMMIT MEDICAL GROUP PLLC",
        "enumeration_date": "2025-03-03",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-25",
        "status": "A",
        "authorized_official_last_name": "BOWLES",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "DEE",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT COORDINATOR",
        "authorized_official_telephone_number": "865-584-4747"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hometown Pediatric Jefferson City",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hometown Pediatric Jefferson City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jefferson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.