Organization Active NPI

Summit Medical Group, PLLC

  • Pediatrics Physician
  • Morristown, TN
National Provider Identifier
1285132845
Registry record updated Mar 28, 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 Morristown
Practice address
1817 W Morris Blvd
Morristown, TN 37813-2837
Phone
(423) 581-3904
Fax
(423) 581-6120
NPI assigned
Jan 30, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

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

Authorized official

Name
Sandra Bowles
Title
Provider Enrollment Coordinator
Phone
(655) 844-7478

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1817 W Morris Blvd
Morristown, TN 37813-2837

Mailing address

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

Other practice location 1

629 Middle Creek Rd
Sevierville, TN 37862-5014
Phone (865) 453-9980

Other practice location 2

125 Mossy Creek Drive
Jefferson City, TN 37760-2421
Phone (865) 475-5377

Other names 1

  • Hometown Pediatric Morristown Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031125000793 TN Part B Supplier - Clinic/Group Practice 2860396330 Receives reassigned benefits from 1,153 practitioners
This NPI is an additional NPI on the enrollment

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
44D0311809Hometown Pediatric Morristown1817 W Morris Blvd, Morristown, TN 37813AccreditationMar 19, 2027

National Provider Directory

National Provider Directory

Locations

125 Mossy CRK Dr
Jefferson City, TN 37760
Phone (865) 475-5377

9333 Park West Blvd
Knoxville, TN 37923
Phone (865) 531-4600

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1517270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743120000000",
    "number": "1285132845",
    "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": "1817 W MORRIS BLVD",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378132837",
            "telephone_number": "423-581-3904",
            "fax_number": "423-581-6120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "629 Middle Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Sevierville",
            "state": "TN",
            "postal_code": "378625014",
            "country_code": "US",
            "telephone_number": "865-453-9980",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "125 Mossy Creek Drive",
            "address_purpose": "LOCATION",
            "city": "Jefferson City",
            "state": "TN",
            "postal_code": "377602421",
            "country_code": "US",
            "telephone_number": "865-475-5377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUMMIT MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-30",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-26",
        "status": "A",
        "authorized_official_last_name": "BOWLES",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT COORDINATOR",
        "authorized_official_telephone_number": "655-844-7478"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hometown Pediatric Morristown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Morristown, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; 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.