NPIMap

Organization Active NPI

University of Tennessee

Doing business as Center on Developmental Disabilities

  • Developmental Disabilities Clinic/Center
  • Memphis, TN
National Provider Identifier
1427064880
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
License
LM222M20956033 Issued in TN
Legal business name
UNIVERSITY OF TENNESSEE
Doing business as
Center on Developmental Disabilities
Practice address
920 Madison Ave Ste 939
Memphis, TN 38103-3438
Phone
(901) 448-6511
Fax
(901) 448-3844
NPI assigned
Jul 31, 2006
Last updated
Aug 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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

Authorized official

Name
Dr. Bruce Keisling, PHDNPI 1699881318
Title
Director
Phone
(901) 448-6511

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
Developmental Disabilities Clinic/Center 261QD1600X LM222M20956033 TN Primary

Addresses

Primary practice location

920 Madison Ave Ste 939
Memphis, TN 38103-3438

Mailing address

920 Madison Ave Ste 939
Memphis, TN 38103-3438
Phone (901) 448-6511

Other identifiers 1

IdentifierTypeStateIssuer
4447962MedicaidTN

Other names 2

  • Center on Developmental Disabilities Doing business as
  • Boling Center for Developmental Disabilities Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031217000979 TN Part B Supplier - Clinic/Group Practice 3072421213 Receives reassigned benefits from 3 practitioners
Practice locations: Memphis, TN
O20040110000145 TN Part B Supplier - Clinic/Group Practice 3072421213 Receives reassigned benefits from 94 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Knoxville, TN
O20040119000515 TN Part B Supplier - Clinic/Group Practice 3072421213 Receives reassigned benefits from 26 practitioners
1 other NPI on this enrollment
Practice locations: Knoxville, TN; Memphis, TN

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

711 Jefferson Ave
Rm 206B
Memphis, TN 38105
Phone (901) 448-6511

Practitioners & affiliated clinicians

Practitioners 56

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 56

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691971200000",
    "number": "1427064880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 MADISON AVE STE 939",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381033438",
            "telephone_number": "901-448-6511",
            "fax_number": "901-448-3844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 MADISON AVE STE 939",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381033438",
            "telephone_number": "901-448-6511",
            "fax_number": "901-448-3844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A",
        "authorized_official_last_name": "KEISLING",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "901-448-6511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "TN",
            "license": "LM222M20956033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4447962",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center on Developmental Disabilities",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Boling Center for Developmental Disabilities",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.