Organization Active NPI

Primary Care and Geriatrics, PC

  • Geriatric Medicine (Family Medicine) Physician
  • Morristown, TN
National Provider Identifier
1669676490
Registry record updated Aug 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
PRIMARY CARE AND GERIATRICS, PC
Practice address
711 McFarland St
Morristown, TN 37814
Phone
(423) 317-7412
Fax
(423) 317-7415
NPI assigned
Jun 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2015

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

Authorized official

Name
Mrs. Angula Gupta
Title
Office Manager
Phone
(423) 317-7412

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X

Addresses

Primary practice location

711 McFarland St
Morristown, TN 37814

Mailing address

711 McFarland St
Morristown, TN 37814-3977
Phone (423) 317-7412

Other identifiers 2

IdentifierTypeStateIssuer
080190473OtherTNRAILROAD MEDICARE
3372546MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100121000472 TN Part B Supplier - Clinic/Group Practice 3577605054 Receives reassigned benefits from 7 practitioners
Practice locations: Morristown, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D1004660Primary Care and Geriatrics PC711 McFarland St, Morristown, TN 37814Certificate of waiverOct 1, 2026

National Provider Directory

National Provider Directory

Locations

1423 W Morris Blvd
Ste B
Morristown, TN 37813
Phone (423) 586-0106

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440979200000",
    "number": "1669676490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 MCFARLAND ST",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378143977",
            "telephone_number": "423-317-7412",
            "fax_number": "423-317-7415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 MCFARLAND ST",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "37814",
            "telephone_number": "423-317-7412",
            "fax_number": "423-317-7415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE AND GERIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2015-08-31",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "ANGULA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "423-317-7412",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080190473",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3372546",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morristown, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.