NPIMap

Organization Active NPI

Greenbrier Medical

  • Family Nurse Practitioner
  • Sevierville, TN
National Provider Identifier
1285066407
Registry record updated Jul 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
13614 Issued in TN
Legal business name
GREENBRIER MEDICAL
Practice address
1110 Village Dr
Sevierville, TN 37862-5028
Phone
(865) 453-0792
Fax
(865) 429-5006
NPI assigned
Jul 30, 2013
Last updated
Jul 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2013

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

Authorized official

Name
Melissa Ann Large, MSN, FNP
Title
Family Nurse Practitioner
Phone
(865) 453-0792

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 13614 TN Primary

Addresses

Primary practice location

1110 Village Dr
Sevierville, TN 37862-5028

Mailing address

1110 Village Dr
Sevierville, TN 37862-5028
Phone (865) 453-0792

Other identifiers 1

IdentifierTypeStateIssuer
APN 13614OtherTNLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200630003300 TN Part B Supplier - Clinic/Group Practice 9234552753 Receives reassigned benefits from 7 practitioners
Practice locations: Sevierville, TN

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
44D2071892Greenbrier Medical1110 Village Dr, Suite a, Sevierville, TN 37862Certificate of waiverJan 20, 2028

National Provider Directory

National Provider Directory

Locations

742 Middle Creek Rd
Sevierville, TN 37862
Phone (865) 429-6100

Practitioners & affiliated clinicians

Practitioners 11

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": "1375142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375142400000",
    "number": "1285066407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 VILLAGE DR",
            "city": "SEVIERVILLE",
            "state": "TN",
            "postal_code": "378625028",
            "telephone_number": "865-453-0792",
            "fax_number": "865-429-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 VILLAGE DR",
            "city": "SEVIERVILLE",
            "state": "TN",
            "postal_code": "378625028",
            "telephone_number": "865-453-0792",
            "fax_number": "865-429-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENBRIER MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-30",
        "last_updated": "2013-07-30",
        "status": "A",
        "authorized_official_last_name": "LARGE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "865-453-0792",
        "authorized_official_credential": "MSN, FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "13614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "APN 13614",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sevierville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.