NPIMap

Organization Active NPI

Summit Convenient Care at Lebanon LLC

  • Nurse Practitioner
  • Lebanon, TN
National Provider Identifier
1568627271
Registry record updated May 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
SUMMIT CONVENIENT CARE AT LEBANON LLC
Practice address
100 Physicians Way
Suite 110
Lebanon, TN 37090-8102
Phone
(615) 449-1100
Fax
(615) 449-1150
NPI assigned
Jul 22, 2008
Organization subpart
Yes
Parent organization
HOSPITAL CORP LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 20, 2010

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

Authorized official

Name
Gary Duncan
Title
Vice President
Phone
(615) 372-5135

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

100 Physicians Way
Suite 110
Lebanon, TN 37090-8102

Mailing address

100 Physicians Way
Suite 110
Lebanon, TN 37090-8102
Phone (615) 449-1100

Other identifiers 3

IdentifierTypeStateIssuer
1511412MedicaidTN
4214465OtherTNBCBS
DO3658OtherTNRR MEDICARE

National Provider Directory

National Provider Directory

Locations

100 Physicians Way
Ste 110
Lebanon, TN 37090
Phone (615) 449-1100

Practitioners & affiliated clinicians

Practitioners 7

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": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274313600000",
    "number": "1568627271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PHYSICIANS WAY",
            "address_2": "SUITE 110",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370908102",
            "telephone_number": "615-449-1100",
            "fax_number": "615-449-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PHYSICIANS WAY",
            "address_2": "SUITE 110",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370908102",
            "telephone_number": "615-449-1100",
            "fax_number": "615-449-1150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT CONVENIENT CARE AT LEBANON LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOSPITAL CORP LLC",
        "enumeration_date": "2008-07-22",
        "last_updated": "2010-05-20",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-372-5135"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1511412",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4214465",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DO3658",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; 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.