NPIMap

Individual provider Active NPI

Albert Russell Vaughn, MD

  • Pediatrics Physician
  • Jefferson City, TN
National Provider Identifier
1689084865
Registry record updated Jun 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD0000057030 Issued in TN
Practice address
120 Hospital Dr Ste 130
Jefferson City, TN 37760-5279
Phone
(864) 475-4742
Fax
(865) 262-0100
NPI assigned
Apr 28, 2014
Last updated
Jun 26, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD0000057030 TN
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X MD0000057030 TN Primary

Addresses

Primary practice location

120 Hospital Dr Ste 130
Jefferson City, TN 37760-5279

Mailing address

1225 E Weisgarber Rd Ste 200
Knoxville, TN 37909-2675
Phone (865) 584-4747

Other practice location 1

910 Madison Ave
Suite 1031
Memphis, TN 38103-3403
Phone (901) 448-5814

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180823001539 TN Practitioner - Pediatric Medicine 7315296332 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Tennessee, HSC, College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Medical Group, PLLCGroup PAC ID 2860396330, 636 clinicians

Practice addresses (Care Compare)

380 W Broadway Blvd
Jefferson City, TN 37760-5279
Phone (865) 475-4742

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD0000057030TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
App of Tennessee HM, PLLC CurrentSince Aug 4, 2019 Accepting new patients
Summit Medical Group, PLLC Internal Medicine CurrentSince Aug 1, 2018 Accepting new patients
Summit Medical Group, PLLC Internal Medicine CurrentSince Aug 1, 2018 Accepting new patients
Summit Medical Group PLLC PastSince Mar 24, 2024 Accepting new patients
Summit Medical Group,PLLC Internal Medicine Past Accepting new patients
Summit Medical Group, PLLC Internal Medicine Past Accepting new patients

Locations

380 W Broadway Blvd
Jefferson City, TN 37760
Phone (865) 450-9361

380 W Broadway Blvd
Ste 130
Jefferson City, TN 37760
Phone (865) 475-4742

110 Hospital Dr
Jefferson Cty, TN 37760
Phone (865) 471-2431

1225 E Weisgarber Rd
Ste 200
Knoxville, TN 37909
Phone (865) 938-3627

435 2nd St
Newport, TN 37821
Phone (423) 625-2200

2835 Highway 231 N
Shelbyville, TN 37160
Phone (931) 685-5433

Interoperability endpoints

  • Direct secure messaging: albert.vaughn.1@20785.direct.athenahealth.com

Organizations & group practices 6

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

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1398643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1689084865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 E WEISGARBER RD STE 200",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092675",
            "telephone_number": "865-584-4747",
            "fax_number": "865-584-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 HOSPITAL DR STE 130",
            "city": "JEFFERSON CITY",
            "state": "TN",
            "postal_code": "377605279",
            "telephone_number": "864-475-4742",
            "fax_number": "865-262-0100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "910 Madison Ave",
            "address_2": "Suite 1031",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381033403",
            "country_code": "US",
            "telephone_number": "901-448-5814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAUGHN",
        "first_name": "ALBERT",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-28",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD0000057030",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "MD0000057030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, TN

Sources for this page

Verify at the official NPI Registry.