NPIMap

Organization Active NPI

Roane County Medical Center

  • Psychiatry Physician
  • Harriman, TN
National Provider Identifier
1821274481
Registry record updated Aug 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
0000019665 Issued in TN
Legal business name
ROANE COUNTY MEDICAL CENTER
Practice address
319 Devonia St
Harriman, TN 37748-2008
Phone
(865) 882-4440
Fax
(865) 882-4447
NPI assigned
Jan 14, 2008
Organization subpart
Yes
Parent organization
COVENANT HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 12, 2009

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

Authorized official

Name
Angel R Hall-Phillips
Title
Department Assistant
Phone
(865) 882-8856

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X LSW0000003925 TN
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X MD42907 TN
Infectious Disease PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RI0200X MD39076 TN
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X 0000019665 TN Primary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X 0000026123 TN
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X 0000039000 TN
General Acute Care Hospital 282N00000X 0000000098 TN
Geropsychiatric Psychiatric/Mental Health Clinical Nurse SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 364SP0813X 0000077192 TN

Addresses

Primary practice location

319 Devonia St
Harriman, TN 37748-2008

Mailing address

PO Box 1646
Harriman, TN 37748-1646
Phone (865) 882-4440

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090725000014 TN Part B Supplier - Clinic/Group Practice 8921167545 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
Practice locations: Harriman, TN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Roane County Medical Center

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250035200000",
    "number": "1821274481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1646",
            "city": "HARRIMAN",
            "state": "TN",
            "postal_code": "377481646",
            "telephone_number": "865-882-4440",
            "fax_number": "865-882-4447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 DEVONIA ST",
            "city": "HARRIMAN",
            "state": "TN",
            "postal_code": "377482008",
            "telephone_number": "865-882-4440",
            "fax_number": "865-882-4447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROANE COUNTY MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COVENANT HEALTH",
        "enumeration_date": "2008-01-14",
        "last_updated": "2009-08-12",
        "status": "A",
        "authorized_official_last_name": "HALL-PHILLIPS",
        "authorized_official_first_name": "ANGEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DEPARTMENT ASSISTANT",
        "authorized_official_telephone_number": "865-882-8856"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "LSW0000003925",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD42907",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "TN",
            "license": "MD39076",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "0000019665",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "0000026123",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "0000039000",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TN",
            "license": "0000000098",
            "primary": false
        },
        {
            "code": "364SP0813X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Geropsychiatric",
            "state": "TN",
            "license": "0000077192",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harriman, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2009; 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.

Verify at the official NPI Registry.