Organization Active NPI

Family Health Care of Hendersonville, PLLC

  • Family Medicine Physician
  • Hendersonville, TN
National Provider Identifier
1699012716
Registry record updated Oct 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY HEALTH CARE OF HENDERSONVILLE, PLLC
Practice address
211 Indian Lake Blvd Ste a
Hendersonville, TN 37075-6442
Phone
(615) 826-3100
Fax
(615) 447-1060
NPI assigned
Jan 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2023

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

Authorized official

Name
Dr. Anthony V. Dallas Jr., MDNPI 1861437063
Title
Owner
Phone
(615) 826-3100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

211 Indian Lake Blvd Ste a
Hendersonville, TN 37075-6442

Mailing address

211 Indian Lake Blvd Ste a
Hendersonville, TN 37075-6442
Phone (615) 826-3100

Other identifiers 1

IdentifierTypeStateIssuer
3374461MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040116000305 TN Part B Supplier - Clinic/Group Practice 1850292426 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: Hendersonville, TN

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

211 Indian Lake Blvd
Ste A
Hendersonvlle, TN 37075
Phone (615) 826-3100

353 New Shackle Island Rd
Ste 141C
Hendersonvlle, TN 37075
Phone (615) 826-3100

Practitioners & affiliated clinicians

Practitioners 8

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": "1357689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697760000000",
    "number": "1699012716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 INDIAN LAKE BLVD STE A",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370756442",
            "telephone_number": "615-826-3100",
            "fax_number": "615-447-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 INDIAN LAKE BLVD STE A",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370756442",
            "telephone_number": "615-826-3100",
            "fax_number": "615-447-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CARE OF HENDERSONVILLE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-09",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A",
        "authorized_official_last_name": "DALLAS",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-826-3100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3374461",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hendersonville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.