NPIMap

Organization Active NPI

University Health System, Inc

Doing business as UT Primary Care Jamestown

  • Family Medicine Physician
  • Jamestown, TN
National Provider Identifier
1669164307
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UNIVERSITY HEALTH SYSTEM, INC
Doing business as
UT Primary Care Jamestown
Practice address
208 Central Ave W
Jamestown, TN 38556-3557
Phone
(865) 670-6754
NPI assigned
May 22, 2023
Last updated
May 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2023

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

Authorized official

Name
Carol A Burgess
Title
Provider Enrollment Team Lead
Phone
(865) 670-6754

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

208 Central Ave W
Jamestown, TN 38556-3557

Mailing address

PO Box 415000-Msc8443
Nashville, TN 37241-8443
Phone (865) 670-6199

Other names 1

  • UT Primary Care Jamestown Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000809 TN Part B Supplier - Clinic/Group Practice 5294646378 Receives reassigned benefits from 881 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Unversity Health System Inc68 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 3

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": "1684713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1669164307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415000-MSC8443",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372418443",
            "telephone_number": "865-670-6199",
            "fax_number": "865-670-6198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 CENTRAL AVE W",
            "city": "JAMESTOWN",
            "state": "TN",
            "postal_code": "385563557",
            "telephone_number": "865-670-6754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY HEALTH SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-22",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT TEAM LEAD",
        "authorized_official_telephone_number": "865-670-6754"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UT Primary Care Jamestown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jamestown, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 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.