Collierville Pediatrics, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

38751 Issued in TN

Legal business name

COLLIERVILLE PEDIATRICS, LLC

Practice address

2028 W Poplar Ave
Suite 112
Collierville, TN 38017-0618

Phone

(901) 854-5455

Fax

(901) 377-7309

NPI assigned

Nov 19, 2007

Last updated

Nov 19, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jaya Venkataraman, MDNPI 1487654752

Title

MD/President

Phone

(901) 854-5455

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Practitioners 7

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.

• Jaya Venkataraman, MD

  • Pediatrics Physician
  • Germantown, TN
  • NPI 1487654752
  Medicare reassignment NPD Authorized official
• William Bradley Lofton, M.D.

  • Internal Medicine Physician
  • Memphis, TN
  • NPI 1114927969
  Medicare reassignment NPD
• Kimberly M Randolph, APN

  • Nurse Practitioner
  • Germantown, TN
  • NPI 1144544982
  Medicare reassignment NPD
• Marie Oliva Hennelly, M.D.

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1912393539

  TN

  Medicare reassignment NPD
• Sania Sayani, MD

  • Family Medicine Physician
  • Warren, AR
  • NPI 1528528809

  TN

  Medicare reassignment NPD
• Jessica Robbins, DNP

  • Pediatric Nurse Practitioner
  • Germantown, TN
  • NPI 1306200738
  NPD
• Krystal Lugo

  • Physician Assistant
  • Germantown, TN
  • NPI 1922627637
  NPD (past)

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

{
    "created_epoch": "1195430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1326229345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2028 W POPLAR AVE",
            "address_2": "SUITE 112",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380170618",
            "telephone_number": "901-854-5455",
            "fax_number": "901-377-7309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2028 W POPLAR AVE",
            "address_2": "SUITE 112",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380170618",
            "telephone_number": "901-854-5455",
            "fax_number": "901-377-7309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIERVILLE PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-19",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "VENKATARAMAN",
        "authorized_official_first_name": "JAYA",
        "authorized_official_title_or_position": "MD/PRESIDENT",
        "authorized_official_telephone_number": "901-854-5455",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "38751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Collierville Healthcare Corp (Pinnacle Pharmacy)
• Collierville Medical Assoc Inc
• Collierville Medical Specialists
• Collierville Nursing and Rehabilitation LLC (Collierville Nursing and Rehabilitation)
• Collierville Orthopedics and
• Collierville Vision Center PLLC
• Comfort Care Transit Solutions LLC
• Comfort Home Sleep Test Corp
• Core Care Assistance LLC
• Core Psychiatry Inc.

• Pediatrics Physician in Collierville, TN
• Providers in Collierville, TN by specialty
• Pediatrics Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; 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.