NPIMap

Organization Active NPI

East Tennessee Children'S Hospital Association, Inc.

  • Pediatric Nephrology Physician
  • Knoxville, TN
National Provider Identifier
1770722688
Registry record updated Sep 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nephrology PhysicianTaxonomy code 2080P0210X
Legal business name
EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC.
Practice address
2100 Clinch Ave Ste 310
Knoxville, TN 37916-2220
Phone
(865) 546-3111
Fax
(877) 761-6691
NPI assigned
Feb 17, 2009
Organization subpart
Yes
Parent organization
EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 5, 2026

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

Authorized official

Name
Andrew Rosendahl
Title
Chief Financial Officer
Phone
(865) 541-8154

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Pediatric Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0210X Primary
Medical Specialty Clinic/Center 261QM2500X

Addresses

Primary practice location

2100 Clinch Ave Ste 310
Knoxville, TN 37916-2220

Mailing address

PO Box 50068
Knoxville, TN 37950-0068
Phone (865) 541-8895

Other identifiers 1

IdentifierTypeStateIssuer
Q004289MedicaidTN

Other names 2

  • Dolly Parton Children's Hospital Nephrology and Hypertension Doing business as
  • East Tennessee Children's Hospital Pediatric Nephrology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040601000461 TN Part B Supplier - Clinic/Group Practice 6204817661 Receives reassigned benefits from 6 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oak Ridge, TN; Knoxville, TN; Cleveland, TN

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
44D1043182Pediatric Nephrology2100 Clinch Ave Mob Suite #310, Knoxville, TN 37916Certificate of waiverJan 10, 2028

National Provider Directory

National Provider Directory
Tax ID family
East Tennessee Children'S28 organizations share this tax ID, including this one
Part of
East Tennessee Children'S

Other organizations with this tax ID 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1234828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788566400000",
    "number": "1770722688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50068",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379500068",
            "telephone_number": "865-541-8895",
            "fax_number": "865-633-4808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 CLINCH AVE STE 310",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379162220",
            "telephone_number": "865-546-3111",
            "fax_number": "877-761-6691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION, INC.",
        "enumeration_date": "2009-02-17",
        "last_updated": "2026-09-05",
        "certification_date": "2026-09-05",
        "status": "A",
        "authorized_official_last_name": "ROSENDAHL",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "865-541-8154"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0210X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q004289",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dolly Parton Children's Hospital Nephrology and Hypertension",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Tennessee Children's Hospital Pediatric Nephrology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2026; 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.