Mary Christy Lipscomb, AG-ACNP-BC

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

17817 Issued in TN

Practice address

1508 Tombras Ave
East Ridge, TN 37412-2720

Phone

(423) 867-4969

Fax

(423) 867-4971

NPI assigned

Jul 27, 2013

Last updated

Jan 6, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EEIHBD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cleveland Medical Associates, PLLC

  • Internal Medicine Physician
  • Cleveland, TN
  • NPI 1093723330
  Medicare reassignment NPD
• Kaful Double Portion Family Practice, Inc

  • Family Nurse Practitioner
  • Cleveland, TN
  • NPI 1386049476
  Medicare reassignment NPD

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

{
    "created_epoch": "1374883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452038400000",
    "number": "1790127090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 TOMBRAS AVE",
            "city": "EAST RIDGE",
            "state": "TN",
            "postal_code": "374122720",
            "telephone_number": "423-867-4969",
            "fax_number": "423-867-4971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 TOMBRAS AVE",
            "city": "EAST RIDGE",
            "state": "TN",
            "postal_code": "374122720",
            "telephone_number": "423-867-4969",
            "fax_number": "423-867-4971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIPSCOMB",
        "first_name": "MARY",
        "middle_name": "CHRISTY",
        "name_prefix": "Mrs.",
        "credential": "AG-ACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-27",
        "last_updated": "2016-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TN",
            "license": "17817",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TN",
            "license": "17817",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TN",
            "license": "17817",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q014366",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENNESSEE",
            "identifier": "6050407",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Khodiyar Health LLC (Stop-N-Go Discount Pharmacy)
• Joan Elizabeth Kramer, PTA
• Amy Dawn Latham, N.P.
• Marcile Helen Leaf, FNP-C
• Life Care Centers of America, Inc. (Life Care Center of East Ridge)
• Tami Lyn Lloyd, FNP-C
• Caroline A Lolay
• Loving Hands Caregiver
• Laura Andrei Martin, PHARMD
• Elizabeth Masengil, DPT

• Acute Care Nurse Practitioner in East Ridge, TN
• Providers in East Ridge, TN by specialty
• Acute Care Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.