NPIMap

Organization Active NPI

Memphis & Shelby County Pediatric Group

  • Pediatric Adolescent Medicine Physician
  • Memphis, TN
National Provider Identifier
1487797536
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
MEMPHIS & SHELBY COUNTY PEDIATRIC GROUP
Practice address
6479 Winchester Rd
Suite 118
Memphis, TN 38115-4240
Phone
(901) 866-2133
Fax
(901) 866-2136
NPI assigned
Feb 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Katherine Carter
Title
Billing Supervisor
Phone
(901) 396-8366

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

6479 Winchester Rd
Suite 118
Memphis, TN 38115-4240

Mailing address

1444 E Shelby Dr
Suite 317
Memphis, TN 38116-7260
Phone (901) 396-8281

Other identifiers 2

IdentifierTypeStateIssuer
117847OtherTNUNISON
5598466OtherTNAETNA

National Provider Directory

National Provider Directory
Tax ID family
Memphis Shelby County Ped Group2 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.

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487797536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1444 E SHELBY DR",
            "address_2": "SUITE 317",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381167260",
            "telephone_number": "901-396-8281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6479 WINCHESTER RD",
            "address_2": "SUITE 118",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381154240",
            "telephone_number": "901-866-2133",
            "fax_number": "901-866-2136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMPHIS & SHELBY COUNTY PEDIATRIC GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "901-396-8366"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "117847",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5598466",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.