Organization Active NPI

Roundtree Mental Health Group PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Lebanon, TN
National Provider Identifier
1376308635
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
ROUNDTREE MENTAL HEALTH GROUP PLLC
Practice address
1633 W Main St Ste 1401
Lebanon, TN 37087-3423
Phone
(931) 288-4619
Fax
(931) 208-4063
NPI assigned
Feb 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Authorized official

Name
Jordan Roundtree, NPNPI 1871286989
Title
Pmhnp
Phone
(615) 969-4271

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)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

1633 W Main St Ste 1401
Lebanon, TN 37087-3423

Mailing address

4180 Coles Ferry Pike
Lebanon, TN 37087-9603
Phone (615) 969-4271

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240323000096 TN Part B Supplier - Clinic/Group Practice 8628415817 Receives reassigned benefits from 2 practitioners
Practice locations: Lebanon, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2323307Roundtree Mental Health Group PLLC1633 W Main St, Suite 1401, Lebanon, TN 37087Certificate of waiverMay 4, 2027

National Provider Directory

National Provider Directory

Locations

142 Public Sq
Ste E104
Lebanon, TN 37087
Phone (931) 288-4619

142 Public Sq
Ste E
Lebanon, TN 37087
Phone (931) 265-2649

1633 W Main St
Ste 1401
Lebanon, TN 37087
Phone (931) 288-4619

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": "1707955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756944000000",
    "number": "1376308635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4180 COLES FERRY PIKE",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370879603",
            "telephone_number": "615-969-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1633 W MAIN ST STE 1401",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370873423",
            "telephone_number": "931-288-4619",
            "fax_number": "931-208-4063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUNDTREE MENTAL HEALTH GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-15",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A",
        "authorized_official_last_name": "ROUNDTREE",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "PMHNP",
        "authorized_official_telephone_number": "615-969-4271",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.