NPIMap

Organization Active NPI

Amg-Southern Tennessee LLC

Doing business as Winchester Pediatrics

  • Pediatrics Physician
  • Winchester, TN
National Provider Identifier
1336294222
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
AMG-SOUTHERN TENNESSEE LLC
Doing business as
Winchester Pediatrics
Practice address
155 Hospital Rd
Suite E
Winchester, TN 37398-2494
Phone
(931) 962-0672
Fax
(931) 967-7817
NPI assigned
Jan 24, 2007
Last updated
Jun 17, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
AMG-SOUTHERN TENNESSEE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Bill Gracey
Title
Coo
Phone
(615) 372-8500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary
Pediatric Cardiology Physician 2080P0202X NU

Addresses

Primary practice location

155 Hospital Rd
Suite E
Winchester, TN 37398-2494

Mailing address

155 Hospital Rd
Suite E
Winchester, TN 37398-2494
Phone (931) 962-0672

Other names 1

  • Winchester Pediatrics 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
Part of
Amg Southern Tennessee LLC

Locations

155 Hospital Rd
Ste E
Winchester, TN 37398
Phone (931) 962-0672

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1336294222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 HOSPITAL RD",
            "address_2": "SUITE E",
            "city": "WINCHESTER",
            "state": "TN",
            "postal_code": "373982494",
            "telephone_number": "931-962-0672",
            "fax_number": "931-967-7817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 HOSPITAL RD",
            "address_2": "SUITE E",
            "city": "WINCHESTER",
            "state": "TN",
            "postal_code": "373982494",
            "telephone_number": "931-962-0672",
            "fax_number": "931-967-7817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG-SOUTHERN TENNESSEE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMG-SOUTHERN TENNESSEE LLC",
        "enumeration_date": "2007-01-24",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "GRACEY",
        "authorized_official_first_name": "BILL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "615-372-8500"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Winchester Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winchester, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.