NPIMap

Organization Active NPI

Portland Primary Care LLC

  • Internal Medicine Physician
  • Portland, TN
National Provider Identifier
1720034226
Registry record updated Dec 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PORTLAND PRIMARY CARE LLC
Practice address
103 Redbud Dr
Suite E
Portland, TN 37148-1617
Phone
(615) 325-1206
Fax
(615) 325-1245
NPI assigned
May 26, 2006
Last updated
Dec 11, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
HTI HOSPITAL HOLDINGS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 11, 2007

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

Authorized official

Name
Jeff Rydburg
Title
VP
Phone
(615) 373-7415

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

103 Redbud Dr
Suite E
Portland, TN 37148-1617

Mailing address

103 Redbud Dr
Suite E
Portland, TN 37148-1617
Phone (615) 325-1206

Other identifiers 1

IdentifierTypeStateIssuer
3734188MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060728000322 TN Part B Supplier - Clinic/Group Practice 6305859851 Receives reassigned benefits from 6 practitioners
Practice locations: Hendersonville, TN; Gallatin, TN

National Provider Directory

National Provider Directory

Locations

1720 Nashville Pike
#A
Gallatin, TN 37066
Phone (615) 230-8601

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197331200000",
    "number": "1720034226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 REDBUD DR",
            "address_2": "SUITE E",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "371481617",
            "telephone_number": "615-325-1206",
            "fax_number": "615-325-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 REDBUD DR",
            "address_2": "SUITE E",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "371481617",
            "telephone_number": "615-325-1206",
            "fax_number": "615-325-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND PRIMARY CARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HTI HOSPITAL HOLDINGS, INC.",
        "enumeration_date": "2006-05-26",
        "last_updated": "2007-12-11",
        "status": "A",
        "authorized_official_last_name": "RYDBURG",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "615-373-7415"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3734188",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; 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.