NPIMap

Organization Active NPI

Gateway Medical Associates, P.C.

  • Internal Medicine Physician
  • Clarksville, TN
National Provider Identifier
1780709451
Registry record updated Jun 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DO1235 Issued in TN
Legal business name
GATEWAY MEDICAL ASSOCIATES, P.C.
Practice address
751 Chesapeake Lane
Ste 101
Clarksville, TN 37040-5263
Phone
(931) 648-0202
Fax
(931) 648-0252
NPI assigned
Mar 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2015

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

Authorized official

Name
Philip H Judd III, CPA
Title
Cpa
Phone
(931) 905-0520

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X DO1235 TN Primary

Addresses

Primary practice location

751 Chesapeake Lane
Ste 101
Clarksville, TN 37040-5263

Mailing address

PO Box 3540
Clarksville, TN 37043-3540
Phone (931) 648-0202

Other identifiers 2

IdentifierTypeStateIssuer
3144330OtherTNBLUE CROSS & BLUE SHIELD
3305160MedicaidTN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434672000000",
    "number": "1780709451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3540",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370433540",
            "telephone_number": "931-648-0202",
            "fax_number": "931-648-0252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 CHESAPEAKE LANE",
            "address_2": "STE 101",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370405263",
            "telephone_number": "931-648-0202",
            "fax_number": "931-648-0252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY MEDICAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2015-06-19",
        "status": "A",
        "authorized_official_last_name": "JUDD",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CPA",
        "authorized_official_telephone_number": "931-905-0520",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "DO1235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "3144330",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3305160",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.