Advantage Family Healthcare, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

ADVANTAGE FAMILY HEALTHCARE, PLLC

Doing business as

Campbell Station Primary Care Associates

Practice address

11541 Kingston Pike 101
Knoxville, TN 37934-3918

Phone

(865) 675-7522

Fax

(865) 671-3196

NPI assigned

Mar 9, 2007

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Robert M Martin, APRN, BC, RN, MTNPI 1922004159

Title

Chief Manager

Phone

(865) 675-7522

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Campbell Station Primary Care Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Tax ID family

Advantage Family Healthcare PLLC2 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.

• Advantage Family Healthcare, PLLC

  dba Campbell Station Primary Care Assoc

  • Family Nurse Practitioner
  • Knoxville, TN
  • NPI 1184629735
  NPD tax ID

Practitioners 1

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.

• Robert M Martin, MS CFNP

  • Family Nurse Practitioner
  • Knoxville, TN
  • NPI 1922004159
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1659403590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11541 KINGSTON PIKE 101",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379343918",
            "telephone_number": "865-675-7522",
            "fax_number": "865-671-3196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11541 KINGSTON PIKE 101",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379343918",
            "telephone_number": "865-675-7522",
            "fax_number": "865-671-3196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE FAMILY HEALTHCARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF MANAGER",
        "authorized_official_telephone_number": "865-675-7522",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "APRN, BC, RN, MT"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP CARITEN ID NUMBER",
            "identifier": "100034888",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3728422",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD OF T",
            "identifier": "4050284",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH RIVER VALL",
            "identifier": "TN103",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE GROUP #",
            "identifier": "190646",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE ID",
            "identifier": "7768236",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST GROUP",
            "identifier": "4029196",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Campbell Station Primary Care Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Clinic/Center in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.