NPIMap

Organization Active NPI

Premier Orthopaedics & Sports Medicine, PLC

  • Durable Medical Equipment & Medical Supplies
  • Hermitage, TN
National Provider Identifier
1710065735
Registry record updated Apr 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC
Practice address
5651 Frist Blvd Ste 711
Hermitage, TN 37076-2061
Phone
(615) 889-3349
Fax
(615) 889-6087
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2019

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

Authorized official

Name
Amanda Grace Fromkin
Title
Director of Credentialing
Phone
(706) 494-3071

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

5651 Frist Blvd Ste 711
Hermitage, TN 37076-2061

Mailing address

PO Box 370
Fortson, GA 31808-0370
Phone (706) 494-3071

Other identifiers 1

IdentifierTypeStateIssuer
3707844MedicaidTN

Other names 1

  • Hughston Clinic Orthopaedics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930045976 TN DME Supplier - Physician - Orthopedic/Orthopedic Surgery 9032023320 1 other NPI on this enrollment
Practice locations: Hermitage, TN

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Premier Ortho Sports Med10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5651 Frist Blvd
Ste 711
Hermitage, TN 37076
Phone (615) 342-6010

Ownership & related parties

Other NPIs on the same Medicare enrollment 1

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

Practitioners 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556409600000",
    "number": "1710065735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "FORTSON",
            "state": "GA",
            "postal_code": "318080370",
            "telephone_number": "706-494-3071",
            "fax_number": "706-494-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5651 FRIST BLVD STE 711",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370762061",
            "telephone_number": "615-889-3349",
            "fax_number": "615-889-6087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2019-04-28",
        "status": "A",
        "authorized_official_last_name": "FROMKIN",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "GRACE",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "706-494-3071"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3707844",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hughston Clinic Orthopaedics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hughston Clinic Orthopaedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hermitage, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2019; 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.