NPIMap

Organization Active NPI

Tennessee Primary Care, LLC

  • Family Medicine Physician
  • Cookeville, TN
National Provider Identifier
1760251946
Registry record updated Jan 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TENNESSEE PRIMARY CARE, LLC
Practice address
768 S Willow Ave Ste a
Cookeville, TN 38501-3892
Phone
(931) 559-6900
NPI assigned
Dec 28, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2024

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

Authorized official

Name
Andrew D Johnson, MDNPI 1184072209
Title
Owner
Phone
(931) 456-2728

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

768 S Willow Ave Ste a
Cookeville, TN 38501-3892

Mailing address

15 Iris LN
Crossville, TN 38555-7528
Phone (931) 456-2728

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240311000942 TN Part B Supplier - Clinic/Group Practice 3870939051 Receives reassigned benefits from 4 practitioners
Practice locations: Cookeville, TN

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1703721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704240000000",
    "number": "1760251946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 IRIS LN",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385557528",
            "telephone_number": "931-456-2728",
            "fax_number": "931-400-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "768 S WILLOW AVE STE A",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385013892",
            "telephone_number": "931-559-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-28",
        "last_updated": "2024-01-03",
        "certification_date": "2023-12-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-456-2728",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 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.