Active NPI
Athens Pediatrics PLLC
- Pediatrics Physician
- Athens, TN
National Provider Identifier
1437397809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD32738
- Legal business name
- ATHENS PEDIATRICS PLLC
- Practice address
- 111 Epperson St
Athens, TN 37303-3478 - Phone
- (423) 745-5955
- Fax
- (423) 745-6423
- NPI assigned
- Jan 23, 2009
- Last updated
- Jan 23, 2009
- 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
- Cindy Ackaouy
- Title
- Office Manager
- Phone
- (423) 745-5955
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD32738 | TN | Primary |
Addresses
Primary practice location
111 Epperson St
Athens, TN 37303-3478
Mailing address
111 Epperson St
Athens, TN 37303-3478
Phone (423) 745-5955
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130919000354 | TN | Part A Provider - Rural Health Clinic | 5496999195 | Practice locations: Athens, TN |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1437397809. Details of each certification follow.
Rural health clinic certification: CCN 448925
- Legal name
- ATHENS PEDIATRICS PLLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 29, 2013
- Last certification
- May 20, 2019
- Ownership / control type
- 1C
- Organization structure
- LLC
- Incorporated
- Jan 1, 2009 in TN
- Enrollment address
- 111 Epperson St
Athens, TN 37303-3478
National Provider Directory
National Provider Directory- Tax ID family
- Athens Pediatrics PLLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Nurse Practitioner
- Athens, TN
- NPI 1659740702
Locations
111 Epperson St
Athens, TN 37303
Phone (423) 745-5955
Ownership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Melanie K Long | 5% Or Greater Direct Ownership Interest | Feb 10, 2018 | 99% |
| W-2 Managing Employee | May 1, 2013 | 100% | |
| Kathryn J Klopfenstein | Limited Partnership Interest | Feb 10, 2018 | 1% |
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Marriage & Family Therapist
- Chattanooga, TN
- NPI 1417395641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232668800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1232668800000",
"number": "1437397809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 EPPERSON ST",
"city": "ATHENS",
"state": "TN",
"postal_code": "373033478",
"telephone_number": "423-745-5955",
"fax_number": "423-745-6423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 EPPERSON ST",
"city": "ATHENS",
"state": "TN",
"postal_code": "373033478",
"telephone_number": "423-745-5955",
"fax_number": "423-745-6423"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ATHENS PEDIATRICS PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-01-23",
"last_updated": "2009-01-23",
"status": "A",
"authorized_official_last_name": "ACKAOUY",
"authorized_official_first_name": "CINDY",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "423-745-5955"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pediatrics",
"state": "TN",
"license": "MD32738",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, TN
- Athens Bone-Joint and Spinal Clinic, PLLC
- Athens City Board of Education
- Athens Clinic of Chiropractic Inc.
- Athens Family Dental
- Athens Pediatrics P.C.
- Athens Pediatrics PLLC
- Athens Physicians Practice LLC (William R. Bowers MD)
- Athens Physicians Practice LLC (Medical Associates of Athens)
- Athens Physicians Practice LLC
- Athens Physicians Practice LLC (Starr Convenient Care)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.