NPIMap

Organization Active NPI

State of Tennessee

Doing business as Tennessee Department of Intellectual and Developmental Disabilities

  • Occupational Therapist
  • Nashville, TN
National Provider Identifier
1417337056
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
STATE OF TENNESSEE
Doing business as
Tennessee Department of Intellectual and Developmental Disabilities
Practice address
301 Stewarts Ferry Pike
Nashville, TN 37214-3340
Phone
(615) 231-5147
Fax
(615) 886-9972
NPI assigned
Jun 8, 2015
Last updated
Jun 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Authorized official

Name
Andy Kidd
Title
Deputy Commissioner
Phone
(615) 253-6710

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU
Occupational Therapist 225X00000X NU Primary

Addresses

Primary practice location

301 Stewarts Ferry Pike
Nashville, TN 37214-3340

Mailing address

315 Deaderick St FL 8
Nashville, TN 37238-3000
Phone (615) 532-6530

Other practice location 1

11437 Milton Wilson Rd
Arlington, TN 38002-4926
Phone (901) 745-7509

Other practice location 2

4850 E Andrew Johnson Hwy
Greeneville, TN 37745-3098
Phone (423) 787-6689

Other identifiers 1

IdentifierTypeStateIssuer
Q017827MedicaidTN

Other names 1

  • Tennessee Department of Intellectual and Developmental Disabilities Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161005001038 TN Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5698687077 Receives reassigned benefits from 7 practitioners
Practice locations: Arlington, TN; Nashville, TN

National Provider Directory

National Provider Directory
Tax ID family
Loudon County Health de202 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

400 Deaderick St
Fl 10
Nashville, TN 37243

400 Deaderick St
Fl 9
Nashville, TN 37243
Phone (615) 532-6530

Ownership & related parties

All facility ownership & control disclosures 18

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Middle Tennessee Mental Health InstituteNashville, TN, CCN 444014 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1995
Moccasin Bend Mental Health InstituteChattanooga, TN, CCN 444002 Hospital Operational/Managerial Control (100%) Jul 1, 2008
Stewart County Community Medical CenterDover, TN, CCN 441848 Federally qualified health center Operational/Managerial Control (100%) Feb 19, 1987
Overton County Health DepartmentLivingston, TN, CCN 441840 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Cannon County Health DepartmentWoodbury, TN, CCN 441828 Federally qualified health center Other Apr 23, 2014
Clay County Health DepartmentCelina, TN, CCN 441831 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Cumberland County Health DepartmentCrossville, TN, CCN 441832 Federally qualified health center Other Apr 23, 2014
Dekalb County Health DepartmentSmithville, TN, CCN 441834 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Fentress County Health DepartmentJamestown, TN, CCN 441835 Federally qualified health center Other Apr 23, 2014
Jackson County Health DepartmentGainesboro, TN, CCN 441837 Federally qualified health center Other Apr 23, 2014
Macon County Health DepartmentLafayette, TN, CCN 441838 Federally qualified health center Other Apr 23, 2014
Pickett County Health DepartmentByrdstown, TN, CCN 441841 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Putnam County Health DepartmentCookeville, TN, CCN 441842 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Smith County Health DepartmentCarthage, TN, CCN 441843 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Van Buren County Health DepartmentSpencer, TN, CCN 441844 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Other (100%)		 Apr 23, 2014
Apr 23, 2014
Warren County Health DepartmentMcMinnville, TN, CCN 441845 Federally qualified health center Other Apr 23, 2014
White County Health DepartmentSparta, TN, CCN 441847 Federally qualified health center Other Apr 23, 2014
Gibson County Health Department/Community Health CenterTrenton, TN, CCN 441968 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2015

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1433721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1417337056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 DEADERICK ST FL 8",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372383000",
            "telephone_number": "615-532-6530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 STEWARTS FERRY PIKE",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372143340",
            "telephone_number": "615-231-5147",
            "fax_number": "615-886-9972"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11437 Milton Wilson Rd",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TN",
            "postal_code": "380024926",
            "country_code": "US",
            "telephone_number": "901-745-7509",
            "fax_number": "901-745-7742",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4850 E Andrew Johnson Hwy",
            "address_purpose": "LOCATION",
            "city": "Greeneville",
            "state": "TN",
            "postal_code": "377453098",
            "country_code": "US",
            "telephone_number": "423-787-6689",
            "fax_number": "423-798-6220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STATE OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-08",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "KIDD",
        "authorized_official_first_name": "ANDY",
        "authorized_official_title_or_position": "DEPUTY COMMISSIONER",
        "authorized_official_telephone_number": "615-253-6710"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q017827",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tennessee Department of Intellectual and Developmental Disabilities",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tennessee Department of Intellectual and Developmental Disabilities",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nashville, TN

Sources for this page

Verify at the official NPI Registry.