NPIMap

Organization Active NPI

Privia Medical Group Tennessee LLC

  • Family Medicine Physician
  • Nashville, TN
National Provider Identifier
1376110858
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRIVIA MEDICAL GROUP TENNESSEE LLC
Practice address
1 Vantage Way Ste C240
Nashville, TN 37228-1580
Phone
(571) 982-6636
Fax
(240) 696-1353
NPI assigned
Jun 4, 2021
Last updated
Aug 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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

Authorized official

Name
Mary Roller
Title
Associate Director/Enrollment
Phone
(770) 312-5226

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Obstetrics & Gynecology Physician 207V00000X NU
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

1 Vantage Way Ste C240
Nashville, TN 37228-1580

Mailing address

950 N Glebe Rd Ste 700
Arlington, VA 22203-4173
Phone (571) 982-6636

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210917001131 TN Part B Supplier - Clinic/Group Practice 0547667552 Receives reassigned benefits from 220 practitioners
Practice locations: Morristown, TN; White House, TN; Mount Juliet, TN; Mt Juliet, TN; Murfreesboro, TN; Nashville, TN; Ooltewah, TN; Paris, TN…

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory

Locations

1032 McCallie Ave
Ste 300
Chattanooga, TN 37403
Phone (423) 308-5038

1000 Physicians Way
Ste 144
Franklin, TN 37067
Phone (615) 437-3132

879 Greenlea Blvd
Ste 103
Gallatin, TN 37066
Phone (615) 461-0656

207 Highway 52 Byp W
Lafayette, TN 37083
Phone (615) 688-2273

823 McFarland St
Morristown, TN 37814
Phone (423) 587-9777

2213 Memorial Blvd
Ste D
Murfreesboro, TN 37129

1 Vantage Way
Ste C240
Nashville, TN 37228
Phone (833) 973-3648

1214 Gallatin Ave
Ste 15
Nashville, TN 37206

330 Wallace Rd
Ste 1
Nashville, TN 37211
Phone (615) 933-2009

9298 Apison Pike
Ste 100
Ooltewah, TN 37363
Phone (423) 813-7333

4816 Main St
Ste L
Spring Hill, TN 37174
Phone (615) 861-4444

Practitioners & affiliated clinicians

Practitioners 252

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.

View all 252

NPI Registry JSON

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

{
    "created_epoch": "1622764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1376110858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N GLEBE RD STE 700",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222034173",
            "telephone_number": "571-982-6636",
            "fax_number": "240-696-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 VANTAGE WAY STE C240",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372281580",
            "telephone_number": "571-982-6636",
            "fax_number": "240-696-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP TENNESSEE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-04",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "ROLLER",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR/ENROLLMENT",
        "authorized_official_telephone_number": "770-312-5226"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; 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.