NPIMap

Organization Active NPI

Northside Medical Professionals, P.C.

  • Family Medicine Physician
  • Columbia, TN
National Provider Identifier
1295044097
Registry record updated Sep 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTHSIDE MEDICAL PROFESSIONALS, P.C.
Practice address
1605 Nashville Hwy
Ste. 200
Columbia, TN 38401-2071
Phone
(931) 540-4210
Fax
(931) 380-1202
NPI assigned
Sep 28, 2010
Last updated
Sep 28, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2010

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

Authorized official

Name
Dr. Shawn Gentry, M.D.NPI 1891708012
Title
Coo
Phone
(931) 540-4210

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1605 Nashville Hwy
Ste. 200
Columbia, TN 38401-2071

Mailing address

1605 Nashville Hwy
Ste. 200
Columbia, TN 38401-2071
Phone (931) 540-4210

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101201000188 TN Part B Supplier - Clinic/Group Practice 8224224357 Receives reassigned benefits from 31 practitioners
Practice locations: Columbia, TN; Lawrenceburg, TN; Lewisburg, 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
44D0912746Northside Medical Professionals PC1605 Nashville Hwy Ste 200, Columbia, TN 38401Provider-performed microscopyMar 10, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1285632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285632000000",
    "number": "1295044097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 NASHVILLE HWY",
            "address_2": "STE. 200",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384012071",
            "telephone_number": "931-540-4210",
            "fax_number": "931-380-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 NASHVILLE HWY",
            "address_2": "STE. 200",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384012071",
            "telephone_number": "931-540-4210",
            "fax_number": "931-380-1202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE MEDICAL PROFESSIONALS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-28",
        "last_updated": "2010-09-28",
        "status": "A",
        "authorized_official_last_name": "GENTRY",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "931-540-4210",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; 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.