Active NPI
University of Tennessee
- Family Medicine Physician
- Memphis, TN
National Provider Identifier
1780686170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- UNIVERSITY OF TENNESSEE
- Practice address
- 1301 Primacy Pkwy
Memphis, TN 38119-0213 - Phone
- (901) 448-0275
- Fax
- (901) 448-0404
- NPI assigned
- Aug 15, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Myra L Sullivan
- Title
- Director
- Phone
- (901) 448-2847
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | TN | Primary |
Addresses
Primary practice location
1301 Primacy Pkwy
Memphis, TN 38119-0213
Mailing address
16 Brentshire SQ
Jackson, TN 38305-2203
Phone (731) 664-0994
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3713025 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031119000671 | TN | Part B Supplier - Clinic/Group Practice | 3072421213 |
Receives reassigned benefits from 54 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Memphis, TN; Jackson, TN |
Other NPIs on the same Medicare enrollment 5
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Oral and Maxillofacial Surgery (Dentist)
- Memphis, TN
- NPI 1215012430
O20031119000671
-
- Oral and Maxillofacial Pathology Dentistry
- Memphis, TN
- NPI 1487723094
O20031119000671
National Provider Directory
National Provider DirectoryLocations
910 Madison Ave
Ste 608
Memphis, TN 38103
Phone (901) 448-6476
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124064000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1780686170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 BRENTSHIRE SQ",
"city": "JACKSON",
"state": "TN",
"postal_code": "383052203",
"telephone_number": "731-664-0994",
"fax_number": "731-664-0866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 PRIMACY PKWY",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381190213",
"telephone_number": "901-448-0275",
"fax_number": "901-448-0404"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "UNIVERSITY OF TENNESSEE",
"organizational_subpart": "NO",
"enumeration_date": "2005-08-15",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "SULLIVAN",
"authorized_official_first_name": "MYRA",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "901-448-2847"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "TN",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3713025",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.