Individual provider Active NPI

Dina Noureldine

  • Family Medicine Physician
  • Germantown, TN
National Provider Identifier
1336720192
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
72175 Issued in TN
Practice address
9047 Poplar Ave Ste 105
Germantown, TN 38138-6401
Phone
(901) 752-2300
Fax
(901) 752-2367
NPI assigned
Apr 14, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 72175 TN Primary

Addresses

Primary practice location

9047 Poplar Ave Ste 105
Germantown, TN 38138-6401

Mailing address

1211 Union Ave Ste 330
Memphis, TN 38104-6655

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241122003974 TN Practitioner - Family Practice 5799210092 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Primary Care Group, LLCGroup PAC ID 0941480131, 108 clinicians

Practice addresses (Care Compare)

9047 Poplar Ave
Suite 105
Germantown, TN 38138-6401
Phone (901) 752-2300

Hospital & facility affiliations

  • Methodist Hospitals of Memphis Hospital, Memphis, TN, CCN 440049
  • Baptist Memorial Hospital Hospital, Memphis, TN, CCN 440048

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
72175TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Group LLC Family Medicine CurrentSince Nov 4, 2024 Accepting new patients
Methodist Healthcare - Memphis Hospitals PastSince Jun 30, 2024 Accepting new patients

Locations

9047 Poplar Ave
Ste 105
Germantown, TN 38138
Phone (901) 752-2300

2961 Canada Rd
Ste 105
Lakeland, TN 38002
Phone (901) 388-0115

1211 Union Ave
Ste 330
Memphis, TN 38104
Phone (901) 478-0954

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1618358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1336720192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 UNION AVE STE 330",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381046655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9047 POPLAR AVE STE 105",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381386401",
            "telephone_number": "901-752-2300",
            "fax_number": "901-752-2367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOURELDINE",
        "first_name": "DINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-14",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "72175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, TN

Sources for this page

Verify at the official NPI Registry.