NPIMap

Organization Active NPI

Amg -Southern Tennessee LLC

  • Internal Medicine Physician
  • Monteagle, TN
National Provider Identifier
1699792390
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
AMG -SOUTHERN TENNESSEE LLC
Practice address
15 S Central Ave
Monteagle, TN 37356-3074
Phone
(931) 924-4045
Fax
(931) 924-4105
NPI assigned
Jul 17, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
AMG-SOUTHERN TENNESSEE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
William Gracey
Title
Ceo
Phone
(615) 372-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

15 S Central Ave
Monteagle, TN 37356-3074

Mailing address

15 S Central Ave
Monteagle, TN 37356-3074
Phone (931) 924-4045

Other identifiers 1

IdentifierTypeStateIssuer
3716448MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013001206 TN Part B Supplier - Clinic/Group Practice 5991765943 Receives reassigned benefits from 112 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tullahoma, TN; Winchester, TN; Decherd, TN; Estill Springs, TN; Fayetteville, TN; Huntland, TN; Lawrenceburg, TN; Lynchburg, TN…

Other NPIs on the same Medicare enrollment 41

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

View all 41

National Provider Directory

National Provider Directory
Part of
Amg Southern Tennessee LLC

Locations

1611 S Locust Ave
Ste 200
Lawrenceburg, TN 38464
Phone (931) 766-4560

491 Majors Blvd
Lynchburg, TN 37352
Phone (931) 759-4727

1610 McArthur St
Manchester, TN 37355
Phone (931) 954-5111

1383 S College St
Winchester, TN 37398
Phone (931) 962-3500

183 Hospital Rd
Ste 8
Winchester, TN 37398

1894 Cowan Hwy
Ste 2
Winchester, TN 37398
Phone (931) 962-1020

2020 Cowan Hwy
Ste 100
Winchester, TN 37398
Phone (931) 967-7939

2092 Cowan Hwy
Winchester, TN 37398
Phone (931) 967-5104

2118 Cowan Hwy
#1
Winchester, TN 37398

Practitioners & affiliated clinicians

Practitioners 92

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.

View all 92

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1699792390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 S CENTRAL AVE",
            "city": "MONTEAGLE",
            "state": "TN",
            "postal_code": "373563074",
            "telephone_number": "931-924-4045",
            "fax_number": "931-924-4105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 S CENTRAL AVE",
            "city": "MONTEAGLE",
            "state": "TN",
            "postal_code": "373563074",
            "telephone_number": "931-924-4045",
            "fax_number": "931-924-4105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG -SOUTHERN TENNESSEE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMG-SOUTHERN TENNESSEE LLC",
        "enumeration_date": "2006-07-17",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "GRACEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-372-8500"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3716448",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monteagle, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.