Interventional Diabetes Center LLC 4

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

INTERVENTIONAL DIABETES CENTER LLC 4

Practice address

440 S Poplar St
Kenton, TN 38233-3622

Phone

(901) 791-1711

NPI assigned

May 5, 2025

Organization subpart

No

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

Authorized official

Name

Maurice Hampton

Title

Owner

Phone

(901) 791-1711

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas J Caruthers Jr., MD

  • Obstetrics & Gynecology Physician
  • Bolivar, TN
  • NPI 1730138355
  Medicare reassignment NPD
• Omar Rashad Davis, M.D.

  • Nephrology Physician
  • Memphis, TN
  • NPI 1588767826
  Medicare reassignment NPD
• Antonio Lavale Knowles, DPM

  • Podiatrist
  • Memphis, TN
  • NPI 1124188511
  Medicare reassignment NPD
• Jessica Rispoli

  • Podiatrist
  • Fargo, ND
  • NPI 1053790410

  TN

  Medicare reassignment
• Miranda D White, APRN

  • Nurse Practitioner
  • Memphis, TN
  • NPI 1427568260
  NPD
• Douglas Michael Farrar, D.D.S.

  • General Practice Dentistry
  • Kenton, TN
  • NPI 1538210257
  NPD (past)

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

{
    "created_epoch": "1746403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1821887944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 S POPLAR ST",
            "city": "KENTON",
            "state": "TN",
            "postal_code": "382333622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 S POPLAR ST",
            "city": "KENTON",
            "state": "TN",
            "postal_code": "382333622",
            "telephone_number": "901-791-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL DIABETES CENTER LLC 4",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-05",
        "last_updated": "2025-09-02",
        "certification_date": "2025-09-02",
        "status": "A",
        "authorized_official_last_name": "HAMPTON",
        "authorized_official_first_name": "MAURICE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-791-1711"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• A&G Miracle Home Care LLC
• Douglas Michael Farrar, D.D.S.
• Greenfield Pharms, LLC
• Cara Marvin, D.PH.
• James C Turner, DPH

• Podiatrist in Kenton, TN
• Providers in Kenton, TN by specialty
• Podiatrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; 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.