NPIMap

Organization Active NPI

Red River Medical Group Corporation

Doing business as Red River Medical Group

  • Internal Medicine Physician
  • Clarksville, TN
National Provider Identifier
1629857248
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
RED RIVER MEDICAL GROUP CORPORATION
Doing business as
Red River Medical Group
Practice address
1110 A Ted Crozier Sr. Blvd
Clarksville, TN 37043-8912
Phone
(931) 538-3039
Fax
(931) 245-5484
NPI assigned
Sep 22, 2023
Last updated
Jan 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Authorized official

Name
Jigar Kanubhai ShahNPI 1013936079
Title
Provider/Co-Owner
Phone
(931) 802-8056

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Family Nurse Practitioner 363LF0000X NU
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

1110 A Ted Crozier Sr. Blvd
Clarksville, TN 37043-8912

Mailing address

1960 Madison St PMB 326
Clarksville, TN 37043-8063
Phone (931) 538-3039

Other names 1

  • Red River Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241028000056 TN Part B Supplier - Clinic/Group Practice 4486187606 Receives reassigned benefits from 6 practitioners
Practice locations: Clarksville, TN

National Provider Directory

National Provider Directory

Locations

1100 Ted a Crozier SR Blvd
Clarksville, TN 37043
Phone (931) 648-1699

1110 Ted a Crozier SR Blvd
Clarksville, TN 37043
Phone (931) 320-9467

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1695340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1629857248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 MADISON ST PMB 326",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370438063",
            "telephone_number": "931-538-3039",
            "fax_number": "931-245-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 A TED CROZIER SR. BLVD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370438912",
            "telephone_number": "931-538-3039",
            "fax_number": "931-245-5484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED RIVER MEDICAL GROUP CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-22",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "JIGAR",
        "authorized_official_middle_name": "KANUBHAI",
        "authorized_official_title_or_position": "PROVIDER/CO-OWNER",
        "authorized_official_telephone_number": "931-802-8056"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red River Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Red River Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; 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.