NPIMap

Organization Active NPI

Ut Medical Group, Inc.

  • Podiatrist
  • Memphis, TN
National Provider Identifier
1336643121
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
UT MEDICAL GROUP, INC.
Practice address
1068 Cresthaven Rd Ste 110
Memphis, TN 38119-0845
Phone
(901) 767-5620
Fax
(901) 763-4326
NPI assigned
Mar 19, 2018
Last updated
Apr 4, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
UT MEDICAL GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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

Authorized official

Name
Courtney Love
Title
Chief Operations Officer
Phone
(901) 866-8105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X Primary

Addresses

Primary practice location

1068 Cresthaven Rd Ste 110
Memphis, TN 38119-0845

Mailing address

Dept #93
PO Box 1000
Memphis, TN 38148-0093
Phone (901) 866-8205

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180718002565 TN DME Supplier - Physician - Podiatry 3173435369 Practice locations: Memphis, TN

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Utmg Pulmonary Medicine10 organizations share this tax ID, including this one
Part of
Utmg Pulmonary Medicine

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1521417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680566400000",
    "number": "1336643121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT #93",
            "address_2": "PO BOX 1000",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381480093",
            "telephone_number": "901-866-8205",
            "fax_number": "901-302-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1068 CRESTHAVEN RD STE 110",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381190845",
            "telephone_number": "901-767-5620",
            "fax_number": "901-763-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UT MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UT MEDICAL GROUP, INC.",
        "enumeration_date": "2018-03-19",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A",
        "authorized_official_last_name": "LOVE",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "901-866-8105"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2023; 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.