NPIMap

Organization Active NPI

American Wound Care Centers

  • Adult Medicine Physician
  • Brentwood, TN
National Provider Identifier
1306585500
Registry record updated Jun 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
AMERICAN WOUND CARE CENTERS
Practice address
5055 Maryland Way Ste 100
Brentwood, TN 37027-7665
Phone
(615) 229-7202
NPI assigned
Jun 3, 2022
Last updated
Jun 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2022

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

Authorized official

Name
Ethan Kellum, MDNPI 1396907705
Title
Owner
Phone
(901) 484-0837

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X NU Primary

Addresses

Primary practice location

5055 Maryland Way Ste 100
Brentwood, TN 37027-7665

Mailing address

5055 Maryland Way Ste 100
Brentwood, TN 37027-7665

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220706001930 TN Part B Supplier - Clinic/Group Practice 0648650853 Receives reassigned benefits from 10 practitioners
Practice locations: Murfreesboro, TN; Brentwood, TN; Pleasant View, TN

National Provider Directory

National Provider Directory

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": "1654214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654214400000",
    "number": "1306585500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5055 MARYLAND WAY STE 100",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5055 MARYLAND WAY STE 100",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277665",
            "telephone_number": "615-229-7202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN WOUND CARE CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-03",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A",
        "authorized_official_last_name": "KELLUM",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-484-0837",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brentwood, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; 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.