NPIMap

Organization Active NPI

Tennessee River Physicians, PLLC

  • Emergency Medicine Physician
  • Chattanooga, TN
National Provider Identifier
1710424882
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
TENNESSEE RIVER PHYSICIANS, PLLC
Practice address
1751 Gunbarrel Rd
Chattanooga, TN 37421-7177
Phone
(423) 778-8700
NPI assigned
Jan 26, 2017
Last updated
Feb 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Authorized official

Name
Kim H Larsen
Title
Director of Credentialing
Phone
(770) 874-5400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

1751 Gunbarrel Rd
Chattanooga, TN 37421-7177

Mailing address

PO Box 20882
Belfast, ME 04915-4105
Phone (770) 874-5400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170629002555 TN Part B Supplier - Clinic/Group Practice 8022387349 Receives reassigned benefits from 190 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chattanooga, TN; Pikeville, TN; Dunlap, TN

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1485388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1710424882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20882",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154105",
            "telephone_number": "770-874-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 GUNBARREL RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374217177",
            "telephone_number": "423-778-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE RIVER PHYSICIANS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-26",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "770-874-5400"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.