Lentz Pediatrics, PLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

LENTZ PEDIATRICS, PLC

Practice address

10777 Highway 412 W
Lexington, TN 38351-6283

Phone

(731) 968-5558

Fax

(731) 968-5567

NPI assigned

Jan 7, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Jonathan D Lentz, MDNPI 1649218603

Title

Physician

Phone

(731) 664-9040

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

Rural health clinic certification: CCN 448908

Legal name

LENTZ PEDIATRICS, PLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jun 1, 2011

Last certification

Jun 11, 2024

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Jan 1, 2008 in TN

Enrollment address

10777 Hwy 412 W
Lexington, TN 38351-6283

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

CLIA laboratory certificates

Tax ID family

Lentz Pediatrics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lentz Pediatrics, PLC

  • Pediatrics Physician
  • Jackson, TN
  • NPI 1942011143
  NPD tax ID

Locations

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.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Jonathan D Lentz, MD

  • Pediatrics Physician
  • Lexington, TN
  • NPI 1649218603

  5% Or Greater Direct Ownership Interest

  CMS ownership

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Lentz Pediatrics, PLC

  • Pediatrics Physician
  • Jackson, TN
  • NPI 1942011143
  NPPES parent name

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jonathan D Lentz, MD

  • Pediatrics Physician
  • Lexington, TN
  • NPI 1649218603
  Medicare reassignment NPD Authorized official
• Kendra D Grissom, NP

  • Pediatric Nurse Practitioner
  • Lexington, TN
  • NPI 1487190112
  Medicare reassignment NPD
• Ashley Kate Melton, CPNP

  • Pediatric Nurse Practitioner
  • Lexington, TN
  • NPI 1174851844
  Medicare reassignment NPD
• Casey Beecham Blair, FNP

  • Family Medicine Physician
  • Lexington, TN
  • NPI 1689326092
  NPD
• Kristen Nicole Massey, MSN, APRN, FNP-C

  • Family Nurse Practitioner
  • Dyersburg, TN
  • NPI 1811454424
  NPD (past)
• Crystal Gail McDaniel, FNP-C

  • Family Nurse Practitioner
  • Lexington, TN
  • NPI 1376815415
  NPD (past)
• Elizabeth Ann Snider, CPNP-PC, RN, APRN

  • Pediatric Nurse Practitioner
  • Lexington, TN
  • NPI 1265932826
  NPD (past)

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

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1467637611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 SECURITY DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053626",
            "telephone_number": "731-664-9040",
            "fax_number": "731-664-9041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10777 HIGHWAY 412 W",
            "city": "LEXINGTON",
            "state": "TN",
            "postal_code": "383516283",
            "telephone_number": "731-968-5558",
            "fax_number": "731-968-5567"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19 Security Dr",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "TN",
            "postal_code": "383053626",
            "country_code": "US",
            "telephone_number": "731-664-9040",
            "fax_number": "731-664-9041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LENTZ PEDIATRICS, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-07",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "LENTZ",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "731-664-9040",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "31704",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1503415",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber Lankford, DPT
• Samuel Latendresse, DPT
• Michael Brent Lawler, LPTA
• Leah B. Gilliam, MD.
• Leslie Lee, FNP
• Jonathan D Lentz, MD
• Gennifer Leslie
• Amber S Lewis, LCSW
• Lexcare Clinic Inc
• Lexington Clinic Corp

• Rural Health Clinic/Center in Lexington, TN
• Providers in Lexington, TN by specialty
• Rural Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.
• 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.