NPIMap

Organization Active NPI

Blues City Psychiatry, PLLC

  • Psychiatry Physician
  • Cordova, TN
National Provider Identifier
1750696340
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
42712 Issued in TN
Legal business name
BLUES CITY PSYCHIATRY, PLLC
Practice address
8336 Macon Rd
Cordova, TN 38018-8554
Phone
(901) 682-3035
Fax
(901) 628-3049
NPI assigned
Aug 9, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Authorized official

Name
Dr. Shubi R Mukatira, MD
Title
Owner
Phone
(901) 737-1992

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 42712 TN Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

8336 Macon Rd
Cordova, TN 38018-8554

Mailing address

1138 N Germantown Pkwy
Suite 101-110
Cordova, TN 38016-5872
Phone (901) 737-1992

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100816000249 TN Part B Supplier - Clinic/Group Practice 7618001470 Receives reassigned benefits from 12 practitioners
Practice locations: Cordova, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2040629Blues City Psychiatry PLLC8336 Macon Road, Cordova, TN 38018Certificate of waiverMay 6, 2028

National Provider Directory

National Provider Directory

Locations

8336 Macon Rd
Cordova, TN 38018
Phone (901) 682-3035

1138 N Germantown Pkwy
Ste 101110
Cordova, TN 38016

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1750696340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1138 N GERMANTOWN PKWY",
            "address_2": "SUITE 101-110",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380165872",
            "telephone_number": "901-737-1992",
            "fax_number": "901-309-8784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8336 MACON RD",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380188554",
            "telephone_number": "901-682-3035",
            "fax_number": "901-628-3049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUES CITY PSYCHIATRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-09",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "MUKATIRA",
        "authorized_official_first_name": "SHUBI",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-737-1992",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "42712",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordova, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.