NPIMap

Organization Active NPI

Memphis Children's Clinic, PLLC

  • Pediatrics Physician
  • Bartlett, TN
National Provider Identifier
1477633303
Registry record updated Jan 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MEMPHIS CHILDREN'S CLINIC, PLLC
Practice address
3155 Kirby Whitten Road
Bartlett, TN 38134-2823
Phone
(901) 379-0092
Fax
(901) 379-0795
NPI assigned
Oct 16, 2006
Last updated
Jan 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2008

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

Authorized official

Name
Robert M Bertin
Title
Practice Manager
Phone
(901) 396-0390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

3155 Kirby Whitten Road
Bartlett, TN 38134-2823

Mailing address

1129 Hale Rd
Memphis, TN 38116-6373
Phone (901) 396-0390

Other identifiers 1

IdentifierTypeStateIssuer
3382354MedicaidTN

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
44D0957613Memphis Children's Clinic PLLC3155 Kirby Whitten Road, Bartlett, TN 38134ComplianceApr 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Memphis Children's Clinic7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

3155 Kirby Whitten Rd
Bartlett, TN 38134
Phone (901) 379-0092

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201478400000",
    "number": "1477633303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 HALE RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381166373",
            "telephone_number": "901-396-0390",
            "fax_number": "901-396-3728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3155 KIRBY WHITTEN ROAD",
            "city": "BARTLETT",
            "state": "TN",
            "postal_code": "381342823",
            "telephone_number": "901-379-0092",
            "fax_number": "901-379-0795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMPHIS CHILDREN'S CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2008-01-28",
        "status": "A",
        "authorized_official_last_name": "BERTIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "901-396-0390"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3382354",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartlett, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.