NPIMap

Organization Active NPI

Premier Orthopaedics & Sports Medicine, PLC

Doing business as Hughston Clinic Orthopaedics

  • Durable Medical Equipment & Medical Supplies
  • Smyrna, TN
National Provider Identifier
1659443828
Registry record updated Aug 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC
Doing business as
Hughston Clinic Orthopaedics
Practice address
300 Stonecrest Blvd
Suite 200
Smyrna, TN 37167-5688
Phone
(615) 355-0533
Fax
(615) 355-0957
NPI assigned
Nov 14, 2006
Last updated
Aug 17, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Authorized official

Name
Amanda Grace Fromkin
Title
Director of Credentialing
Phone
(706) 494-3071

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X TN Primary

Addresses

Primary practice location

300 Stonecrest Blvd
Suite 200
Smyrna, TN 37167-5688

Mailing address

PO Box 370
Fortson, GA 31808-0370
Phone (706) 324-6661

Other identifiers 2

IdentifierTypeStateIssuer
0922510009OtherTNMEDICARE DME
3707844MedicaidTN

Other names 1

  • Hughston Clinic Orthopaedics Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other Ciox Health

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040301001152 TN Part B Supplier - Clinic/Group Practice 9032023320 Receives reassigned benefits from 83 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20100930082627 TN DME Supplier - Physician - Orthopedic/Orthopedic Surgery 9032023320 Practice locations: Smyrna, TN

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Premier Ortho Sports Med10 organizations share this tax ID, including this one
Part of
Premier Ortho Sports Med

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

300 Stonecrest Blvd
Ste 200
Smyrna, TN 37167
Phone (615) 220-4747

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1659443828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "FORTSON",
            "state": "GA",
            "postal_code": "318080370",
            "telephone_number": "706-324-6661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 STONECREST BLVD",
            "address_2": "SUITE 200",
            "city": "SMYRNA",
            "state": "TN",
            "postal_code": "371675688",
            "telephone_number": "615-355-0533",
            "fax_number": "615-355-0957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC",
        "enumeration_date": "2006-11-14",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "FROMKIN",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "GRACE",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "706-494-3071"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME",
            "identifier": "0922510009",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3707844",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "esmd.cioxhealth.com and OID is '2.16.840.1.113883.3.6635.1.1'",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "929 North Point Parkway",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Hughston Clinic Orthopaedics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hughston Clinic Orthopaedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 17, 2023; 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.