NPIMap

Organization Active NPI

University Health System, Inc

Doing business as UT Internal Medicine Pellissippi

  • Internal Medicine Physician
  • Knoxville, TN
National Provider Identifier
1790738763
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
UNIVERSITY HEALTH SYSTEM, INC
Doing business as
UT Internal Medicine Pellissippi
Practice address
9625 Kroger Park Dr
Ste 450
Knoxville, TN 37922-5880
Phone
(865) 690-2992
Fax
(865) 690-2993
NPI assigned
May 18, 2006
Last updated
Jun 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

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

Authorized official

Name
Beth A Maynard
Title
Vice President
Phone
(865) 670-6754

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

9625 Kroger Park Dr
Ste 450
Knoxville, TN 37922-5880

Mailing address

PO Box 415000-Msc8174
Nashville, TN 37241-8174
Phone (865) 670-6199

Other identifiers 1

IdentifierTypeStateIssuer
3285144MedicaidTN

Other names 1

  • UT Internal Medicine Pellissippi Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000809 TN Part B Supplier - Clinic/Group Practice 5294646378 Receives reassigned benefits from 881 practitioners

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
Tax ID family
Faculty Internal Medici68 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Locations

1924 Alcoa Hwy
#U56
Knoxville, TN 37920
Phone (865) 305-9081

2927 Essary Dr
Knoxville, TN 37918
Phone (865) 687-2303

9625 Kroger Park Dr
Ste 450
Knoxville, TN 37922
Phone (865) 690-2992

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Knoxville Rehabilitation HospitalKnoxville, TN, CCN 443037 Hospital 5% Or Greater Direct Ownership Interest (33.33%) Jun 22, 2021
Knoxville Center for Behavioral MedicineKnoxville, TN, CCN 444031 Hospital 5% Or Greater Direct Ownership Interest (20%) Mar 1, 2022
University of TN Medical Center Home Care Services-Home HealthKnoxville, TN, CCN 447230 Home health agency 5% Or Greater Direct Ownership Interest (33%) Jul 1, 2007
University of TN Medical Center Home HealthMorristown, TN, CCN 447500 Home health agency 5% Or Greater Indirect Ownership Interest (33%) Jul 22, 2008
University of TN Medical Center Home Care Services-HospiceKnoxville, TN, CCN 441547 Hospice 5% Or Greater Direct Ownership Interest (33%) May 1, 2007
University of TN Medical Center Hospice ServicesMorristown, TN, CCN 441578 Hospice 5% Or Greater Indirect Ownership Interest (33%) Jul 31, 2008

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 894

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 894

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591315200000",
    "number": "1790738763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415000-MSC8174",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372418174",
            "telephone_number": "865-670-6199",
            "fax_number": "865-670-6198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9625 KROGER PARK DR",
            "address_2": "STE 450",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379225880",
            "telephone_number": "865-690-2992",
            "fax_number": "865-690-2993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY HEALTH SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A",
        "authorized_official_last_name": "MAYNARD",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "865-670-6754"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3285144",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UT Internal Medicine Pellissippi",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UT Internal Medicine Pellissippi",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.