Individual provider Active NPI

Terri L Ponder, LCSW

  • Clinical Social Worker
  • Tullahoma, TN
National Provider Identifier
1679812895
Registry record updated Mar 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
4623 Issued in TN
Practice address
1803 N Jackson St
Tullahoma, TN 37388-2201
Phone
(931) 461-1300
NPI assigned
Feb 7, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 4623 TN Primary

Addresses

Primary practice location

1803 N Jackson St
Tullahoma, TN 37388-2201

Mailing address

1803 N Jackson St
Tullahoma, TN 37388-2201
Phone (931) 461-1300

Other identifiers 1

IdentifierTypeStateIssuer
LSW4623OtherTNMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130327000428 TN Practitioner - Clinical Social Worker 0446495246 Reassigns benefits to 3 organizations
I20251027001853 SC Practitioner - Clinical Social Worker 0446495246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

66 E Flagler St
Miami, FL 33130-1807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Education Assistance Corporation CurrentSince Mar 11, 2013 Accepting new patients
Grow Healthcare Group PA Clinical CurrentSince Aug 26, 2025 Accepting new patients
Rutherford County Primary Care CurrentSince Sep 19, 2016 Accepting new patients

Locations

170 Meeting St
Ste 110
Charleston, SC 29401
Phone (704) 610-1304

222 E Main St
Johnson City, TN 37604
Phone (423) 433-6200

1453 Hope Way
Murfreesboro, TN 37129
Phone (615) 893-9390

40 Burton Hills Blvd
Ste 200
Nashville, TN 37215
Phone (615) 257-8410

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1360195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615161600000",
    "number": "1679812895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 N JACKSON ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882201",
            "telephone_number": "931-461-1300",
            "fax_number": "931-461-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1803 N JACKSON ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882201",
            "telephone_number": "931-461-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONDER",
        "first_name": "TERRI",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-07",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "4623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "LSW4623",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tullahoma, TN

Sources for this page

Verify at the official NPI Registry.