NPIMap

Organization Active NPI

Chestnut Health of Tennessee PLLC

  • Internal Medicine Physician
  • Blountville, TN
National Provider Identifier
1730928706
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CHESTNUT HEALTH OF TENNESSEE PLLC
Practice address
2830 Highway 394
Blountville, TN 37617-5577
Phone
(423) 274-6191
Fax
(703) 649-6188
NPI assigned
May 21, 2024
Last updated
Jun 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Authorized official

Name
Mr. Omair Siraj
Title
Owner
Phone
(703) 964-8199

Specialties & licenses 1

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

Addresses

Primary practice location

2830 Highway 394
Blountville, TN 37617-5577

Mailing address

PO Box 904
Bedford Park, IL 60499-0904
Phone (703) 964-8199

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240828003578 TN Part B Supplier - Clinic/Group Practice 8123567633 Receives reassigned benefits from 12 practitioners
Practice locations: Johnson City, TN; Roan Mountain, TN; Blountville, TN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1716249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1730928706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 904",
            "city": "BEDFORD PARK",
            "state": "IL",
            "postal_code": "604990904",
            "telephone_number": "703-964-8199",
            "fax_number": "703-649-6188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2830 HIGHWAY 394",
            "city": "BLOUNTVILLE",
            "state": "TN",
            "postal_code": "376175577",
            "telephone_number": "423-274-6191",
            "fax_number": "703-649-6188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESTNUT HEALTH OF TENNESSEE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-21",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "SIRAJ",
        "authorized_official_first_name": "OMAIR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-964-8199",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blountville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; 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.