NPIMap

Organization Active NPI

Kidzcare Pediatrics, PLLC

  • Rural Health Clinic/Center
  • Harriman, TN
National Provider Identifier
1760080600
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KIDZCARE PEDIATRICS, PLLC
Practice address
2317 S Roane St
Harriman, TN 37748-8653
Phone
(423) 745-7500
NPI assigned
Oct 13, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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

Authorized official

Name
Angie Lambert
Title
Office Manager
Phone
(423) 745-7500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

2317 S Roane St
Harriman, TN 37748-8653

Mailing address

2317 S Roane St
Harriman, TN 37748-8653

Other names 1

  • Kidzcare Pediatrics Harriman Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL info@kidzcarepeds.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201217001875 TN Part A Provider - Rural Health Clinic 4789728403 Practice locations: Harriman, TN

Rural health clinic certification: CCN 883839

Legal name
KIDZCARE PEDIATRICS, PLLC
Doing business as
KIDZCARE PEDIATRICS HARRIMAN
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 16, 2021
Last certification
Mar 16, 2021
Ownership / control type
1A
Organization structure
OtherProprietary
Enrollment address
2317 S Roane St
Harriman, TN 37748-8653

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
44D2197082Kidzcare Pediatrics2317 S Roane St, Harriman, TN 37748ComplianceSep 6, 2026

National Provider Directory

National Provider Directory
Tax ID family
Kidzcare Pediatric4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Saji K Gopinathan Individual 5% Or Greater Direct Ownership Interest Jul 1, 2008 100%
Corporate OfficerPresident Jul 1, 2008 100%
Operational/Managerial ControlPresident Jul 1, 2008 100%

NPI Registry JSON

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1760080600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2317 S ROANE ST",
            "city": "HARRIMAN",
            "state": "TN",
            "postal_code": "377488653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2317 S ROANE ST",
            "city": "HARRIMAN",
            "state": "TN",
            "postal_code": "377488653",
            "telephone_number": "423-745-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDZCARE PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-13",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "LAMBERT",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "423-745-7500"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@kidzcarepeds.com",
            "affiliation": "N",
            "address_1": "2317 S Roane St",
            "city": "Harriman",
            "state": "TN",
            "country_code": "US",
            "postal_code": "377488653",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kidzcare Pediatrics Harriman",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kidzcare Pediatrics Harriman",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Harriman, TN

Sources for this page

Verify at the official NPI Registry.