Active NPI
Rivergate Pediatrics PC
- Pediatrics Physician
- Goodlettsville, TN
National Provider Identifier
1366438640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- Legal business name
- RIVERGATE PEDIATRICS PC
- Practice address
- 807 Meadowlark LN
Goodlettsville, TN 37072-2307 - Phone
- (615) 859-6650
- Fax
- (615) 851-1983
- NPI assigned
- Sep 22, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Timothy H Eidson, MD
- Title
- Vice President
- Phone
- (615) 859-6650
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | Primary |
Addresses
Primary practice location
807 Meadowlark LN
Goodlettsville, TN 37072-2307
Mailing address
807 Meadowlark LN
Goodlettsville, TN 37072-2307
Phone (615) 859-6650
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3381850 | Medicaid | TN | |
| 2000315 | Other | BCBS OF TN |
National Provider Directory
National Provider DirectoryLocations
807 Meadowlark Ln
Goodlettsville, TN 37072
Phone (615) 859-6650
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127347200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1295913600000",
"number": "1366438640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "807 MEADOWLARK LN",
"city": "GOODLETTSVILLE",
"state": "TN",
"postal_code": "370722307",
"telephone_number": "615-859-6650",
"fax_number": "615-851-1983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "807 MEADOWLARK LN",
"city": "GOODLETTSVILLE",
"state": "TN",
"postal_code": "370722307",
"telephone_number": "615-859-6650",
"fax_number": "615-851-1983"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RIVERGATE PEDIATRICS PC",
"organizational_subpart": "NO",
"enumeration_date": "2005-09-22",
"last_updated": "2011-01-25",
"status": "A",
"authorized_official_last_name": "EIDSON",
"authorized_official_first_name": "TIMOTHY",
"authorized_official_middle_name": "H",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "615-859-6650",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pediatrics",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3381850",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF TN",
"identifier": "2000315",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Goodlettsville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.