NPIMap

Organization Active NPI

Sabin Behavioral Health

  • Clinical Neuropsychologist
  • Smyrna, TN
National Provider Identifier
1619160090
Registry record updated Mar 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
P248 Issued in TN
Legal business name
SABIN BEHAVIORAL HEALTH
Practice address
695 President PL Ste 202
Smyrna, TN 37167-5681
Phone
(615) 269-4990
Fax
(615) 953-9862
NPI assigned
Aug 20, 2007
Last updated
Mar 3, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2017

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

Authorized official

Name
Jessica Elaine Huddleston, MA, MCJNPI 1396136164
Title
Operations Director
Phone
(615) 269-4990

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 29 TN
Professional Counselor 101YP2500X 2601 TN
Clinical Neuropsychologist 103G00000X P248 TN Primary
Clinical Social Worker 1041C0700X 4362 TN
Clinical Social Worker 1041C0700X LSW4894 TN

Addresses

Primary practice location

695 President PL Ste 202
Smyrna, TN 37167-5681

Mailing address

695 President PL Ste 202
Smyrna, TN 37167-5681
Phone (615) 269-4990

Other identifiers 1

IdentifierTypeStateIssuer
1530000MedicaidTN

Other names 1

  • Hillsboro Rehabilitation Center, INC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120618000638 TN Part B Supplier - Clinic/Group Practice 7517121817 Receives reassigned benefits from 5 practitioners
Practice locations: Smyrna, TN

National Provider Directory

National Provider Directory

Locations

695 President Pl
Ste 202
Smyrna, TN 37167
Phone (615) 269-4990

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488499200000",
    "number": "1619160090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 PRESIDENT PL STE 202",
            "city": "SMYRNA",
            "state": "TN",
            "postal_code": "371675681",
            "telephone_number": "615-269-4990",
            "fax_number": "615-953-9862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 PRESIDENT PL STE 202",
            "city": "SMYRNA",
            "state": "TN",
            "postal_code": "371675681",
            "telephone_number": "615-269-4990",
            "fax_number": "615-953-9862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SABIN BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-20",
        "last_updated": "2017-03-03",
        "status": "A",
        "authorized_official_last_name": "HUDDLESTON",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "615-269-4990",
        "authorized_official_credential": "MA, MCJ"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TN",
            "license": "29",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TN",
            "license": "2601",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "TN",
            "license": "P248",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "4362",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "LSW4894",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1530000",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hillsboro Rehabilitation Center, INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Smyrna, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.