Laura Gustafson Porter, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

P2546 Issued in TN

Practice address

7714 Conner Rd Ste 105
Powell, TN 37849-3559

Phone

(865) 947-6220

Fax

(865) 512-1069

NPI assigned

Jul 19, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cherokee Health SystemsGroup PAC ID 3577474295, 128 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: laura.porter.p1@direct.cherokeehealth.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cherokee Health Systems

  • Federally Qualified Health Center (FQHC)
  • Talbott, TN
  • NPI 1134128820
  Medicare reassignment Care Compare group NPD
• Cherokee Health Systems

  • Federally Qualified Health Center (FQHC)
  • White Pine, TN
  • NPI 1699666404
  NPD

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512000000000",
    "number": "1720087901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6350 W ANDREW JOHNSON HWY DEPT 100",
            "city": "TALBOTT",
            "state": "TN",
            "postal_code": "378778605",
            "telephone_number": "800-355-3565",
            "fax_number": "423-714-2355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7714 CONNER RD STE 105",
            "city": "POWELL",
            "state": "TN",
            "postal_code": "378493559",
            "telephone_number": "865-947-6220",
            "fax_number": "865-512-1069"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6350 W Andrew Johnson Hwy",
            "address_purpose": "LOCATION",
            "city": "Talbott",
            "state": "TN",
            "postal_code": "378778605",
            "country_code": "US",
            "telephone_number": "423-587-7337",
            "fax_number": "423-588-0614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORTER",
        "first_name": "LAURA",
        "middle_name": "GUSTAFSON",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-19",
        "last_updated": "2017-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "2546(PROVISIONAL)",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "P2546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3981441",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Powell, TN
• Providers in Powell, TN by specialty
• Clinical Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.