NPIMap

Organization Active NPI

Vanderbilt University Medical Center

Doing business as Vanderbilt Outpatient Pharmacy

  • Community/Retail Pharmacy
  • Nashville, TN
National Provider Identifier
1285091330
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
111952 Issued in AL
Legal business name
VANDERBILT UNIVERSITY MEDICAL CENTER
Doing business as
Vanderbilt Outpatient Pharmacy
Practice address
1211 Medical Center Dr
TVC 1815
Nashville, TN 37232-0004
Phone
(615) 322-6480
Fax
(615) 329-9358
NPI assigned
Jan 20, 2016
Last updated
Mar 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Authorized official

Name
Mark Sullivan
Title
Chief Pharmacy Officer
Phone
(615) 343-9595

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X PH30942 FL
Community/Retail Pharmacy 3336C0003X 1008 TN
Community/Retail Pharmacy 3336C0003X 1190 NE
Community/Retail Pharmacy 3336C0003X 2017035590 MO
Community/Retail Pharmacy 3336C0003X 16229 MS
Community/Retail Pharmacy 3336C0003X TN2111 KY
Community/Retail Pharmacy 3336C0003X 111952 AL Primary
Specialty Pharmacy 3336S0011X PHNR001329 GA

Addresses

Primary practice location

1211 Medical Center Dr
TVC 1815
Nashville, TN 37232-0004

Mailing address

726 Melrose Ave
Nashville, TN 37211-2151
Phone (615) 322-6480

Other identifiers 3

IdentifierTypeStateIssuer
2157740OtherPK
Q026266MedicaidTN
54008081MedicaidKY

Other names 1

  • Vanderbilt Outpatient Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160523001989 TN Part B Supplier - Pharmacy 5092023416 Receives reassigned benefits from 3 practitioners
Practice locations: Nashville, TN
O20160607001883 TN DME Supplier - Pharmacy 5092023416 Practice locations: Nashville, TN

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

Dept AT 40224
Atlanta, GA 31192

1211 Medical Center Dr
#1815
Nashville, TN 37232
Phone (615) 322-6480

Ownership & related parties

All facility ownership & control disclosures 21

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Vanderbilt Clarksville HospitalClarksville, TN, CCN 440035 Hospital 5% Or Greater Indirect Ownership Interest Dec 31, 2020
Vanderbilt Clarksville HospitalClarksville, TN, CCN 44T035 Hospital 5% Or Greater Indirect Ownership Interest (100%) Dec 31, 2020
Vanderbilt Stallworth Rehabilitation HospitalNashville, TN, CCN 443028 Hospital Limited Partnership Interest (49%) Apr 30, 2016
Vanderbilt Wilson County HospitalLebanon, TN, CCN 440193 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2019
Vanderbilt Tullahoma-Harton HospitalTullahoma, TN, CCN 440144 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 9, 2020
Jan 1, 2021
Vanderbilt Bedford HospitalShelbyville, TN, CCN 440137 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 9, 2020
Jan 1, 2021
Vanderbilt Home Care ServicesNashville, TN, CCN 447249 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Apr 30, 2016
Vanderbilt Primary Care DoverDover, TN, CCN 448914 Rural health clinic 5% Or Greater Indirect Ownership Interest Dec 21, 2020
Vanderbilt Integrated Primary Care UnionvilleUnionville, TN, CCN 443456 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 9, 2020
Jan 1, 2021
Vanderbilt Integrated Primary Care WartraceWartrace, TN, CCN 443455 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 9, 2020
Jan 1, 2021
Vanderbilt Integrated Primary Care ShelbyvilleShelbyville, TN, CCN 443454 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 2021
Jan 1, 2021
Vanderbilt Integrated Urgent CareShelbyville, TN, CCN 443457 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 9, 2020
Jan 1, 2021
Vanderbilt Integrated Primary Care Madison StreetShelbyville, TN, CCN 443458 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 9, 2020
Jan 1, 2021
Vanderbilt Pediatric AssociatesHopkinsville, KY, CCN B03840 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2020
Vanderbilt Integrated PediatricsTullahoma, TN, CCN 883853 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Sep 1, 2020
May 1, 2021
Vip Children's Clinic-LafayetteLafayette, TN, CCN 883850 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 30, 2016
Vip Children's Clinic - SpringfieldSpringfield, TN, CCN 883849 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 30, 2016
Vip Childrens Clinic-Pleasant ViewPleasant View, TN, CCN 883848 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 30, 2016
Vanderbilt Integrated Internal Medicine Cedar LaneTullahoma, TN, CCN 883959 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Sep 1, 2020
Dec 1, 2023
Vanderbilt Integrated Internal MedicineTullahoma, TN, CCN 883958 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Sep 1, 2020
Dec 1, 2023
Vanderbilt Integrated Center for Women's HealthTullahoma, TN, CCN 883960 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Sep 1, 2020
May 1, 2021

Owned or controlled facilities with NPI records 21

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 21

Practitioners & affiliated clinicians

Practitioners 5

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": "1453248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1285091330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "726 MELROSE AVE",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372112151",
            "telephone_number": "615-322-6480",
            "fax_number": "615-329-9358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 MEDICAL CENTER DR",
            "address_2": "TVC 1815",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372320004",
            "telephone_number": "615-322-6480",
            "fax_number": "615-329-9358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANDERBILT UNIVERSITY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-20",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CHIEF PHARMACY OFFICER",
        "authorized_official_telephone_number": "615-343-9595"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "FL",
            "license": "PH30942",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "1008",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NE",
            "license": "1190",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2017035590",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "16229",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "TN2111",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "111952",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "GA",
            "license": "PHNR001329",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2157740",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q026266",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54008081",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vanderbilt Outpatient Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vanderbilt Outpatient Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nashville, TN

Sources for this page

Verify at the official NPI Registry.