NPIMap

Organization Active NPI

Informe Healthcare TN, LLC

  • Internal Medicine Physician
  • Chattanooga, TN
National Provider Identifier
1275003295
Registry record updated Apr 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INFORME HEALTHCARE TN, LLC
Practice address
709 Walnut St
Chattanooga, TN 37402-1916
Phone
(423) 266-7721
NPI assigned
Dec 3, 2018
Last updated
Apr 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2020

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

Authorized official

Name
Jodi M CzernejewskiNPI 1982969812
Title
Owner
Phone
(414) 242-5468

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X NU
Infectious Disease Physician 207RI0200X NU
Pulmonary Disease Physician 207RP1001X NU

Addresses

Primary practice location

709 Walnut St
Chattanooga, TN 37402-1916

Mailing address

2741 W Layton Ave Ste 106
Milwaukee, WI 53221-2600
Phone (414) 242-5468

Other practice location 1

2741 W Layton Ave Ste 106
Milwaukee, WI 53221-2600
Phone (414) 242-5468

Other identifiers 1

IdentifierTypeStateIssuer
Q045823MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, KS, LA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20190308001579 TN Part B Supplier - Clinic/Group Practice 0244579290 Receives reassigned benefits from 16 practitioners
Practice locations: Chattanooga, TN; Knoxville, TN; Nashville, TN
O20240102001852 KS Part B Supplier - Clinic/Group Practice 0244579290 Receives reassigned benefits from 3 practitioners
Practice locations: Elwood, KS
O20240912003125 LA Part B Supplier - Clinic/Group Practice 0244579290 Receives reassigned benefits from 1 practitioner
Practice locations: New Orleans, LA

National Provider Directory

National Provider Directory

Locations

2614 Jefferson Hwy
New Orleans, LA 70121
Phone (504) 291-5100

709 Walnut St
Chattanooga, TN 37402
Phone (423) 266-7721

1250 Tennova Medical Way
Knoxville, TN 37909
Phone (800) 324-4777

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588204800000",
    "number": "1275003295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2741 W LAYTON AVE STE 106",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532212600",
            "telephone_number": "414-242-5468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 WALNUT ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374021916",
            "telephone_number": "423-266-7721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2741 W Layton Ave Ste 106",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532212600",
            "country_code": "US",
            "telephone_number": "414-242-5468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INFORME HEALTHCARE TN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-03",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A",
        "authorized_official_last_name": "CZERNEJEWSKI",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-242-5468"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q045823",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; 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.