NPIMap

Organization Active NPI

Amg - Southern Tennessee, LLC

Doing business as Southern Tennessee Primary Care - Hunters Lane Medical

  • Family Medicine Physician
  • Tullahoma, TN
National Provider Identifier
1316480213
Registry record updated Nov 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AMG - SOUTHERN TENNESSEE, LLC
Doing business as
Southern Tennessee Primary Care - Hunters Lane Medical
Practice address
100 Hunters LN
Suite 100
Tullahoma, TN 37388-8263
Phone
(931) 455-4616
Fax
(931) 455-2362
NPI assigned
Nov 24, 2016
Last updated
Nov 24, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2016

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

Authorized official

Name
Jess N. Judy
Title
President
Phone
(615) 920-7214

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

100 Hunters LN
Suite 100
Tullahoma, TN 37388-8263

Mailing address

PO Box 399
Winchester, TN 37398-0399
Phone (931) 455-4616

Other names 1

  • Southern Tennessee Primary Care - Hunters Lane Medical Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013001206 TN Part B Supplier - Clinic/Group Practice 5991765943 Receives reassigned benefits from 112 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tullahoma, TN; Winchester, TN; Decherd, TN; Estill Springs, TN; Fayetteville, TN; Huntland, TN; Lawrenceburg, TN; Lynchburg, TN…

Other NPIs on the same Medicare enrollment 41

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 41

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1479945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479945600000",
    "number": "1316480213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 399",
            "city": "WINCHESTER",
            "state": "TN",
            "postal_code": "373980399",
            "telephone_number": "931-455-4616",
            "fax_number": "931-455-2362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HUNTERS LN",
            "address_2": "SUITE 100",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373888263",
            "telephone_number": "931-455-4616",
            "fax_number": "931-455-2362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG - SOUTHERN TENNESSEE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-24",
        "last_updated": "2016-11-24",
        "status": "A",
        "authorized_official_last_name": "JUDY",
        "authorized_official_first_name": "JESS",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-920-7214"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Tennessee Primary Care - Hunters Lane Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tullahoma, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2016; 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.