NPIMap

Organization Active NPI

Amg - Southern Tennessee, LLC

Doing business as Family Physicians of Estill Springs

  • Family Medicine Physician
  • Tullahoma, TN
National Provider Identifier
1841541117
Registry record updated Jun 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AMG - SOUTHERN TENNESSEE, LLC
Doing business as
Family Physicians of Estill Springs
Practice address
10054 Old Tullahoma Rd
Tullahoma, TN 37388
Phone
(931) 967-8641
Fax
(931) 455-0892
NPI assigned
Sep 27, 2012
Last updated
Jun 26, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
AMG - SOUTHERN TENNESSEE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 26, 2018

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

Authorized official

Name
Sara Miller
Title
Director
Phone
(615) 920-7780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

10054 Old Tullahoma Rd
Tullahoma, TN 37388

Mailing address

10054 Old Tullahoma Rd
Tullahoma, TN 37388-6122
Phone (931) 967-8641

Other identifiers 1

IdentifierTypeStateIssuer
1530024MedicaidTN

Other names 1

  • Family Physicians of Estill Springs Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013001206 TN Part B Supplier - Clinic/Group Practice 5991765943 Receives reassigned benefits from 112 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tullahoma, TN; Winchester, TN; Decherd, TN; Estill Springs, TN; Fayetteville, TN; Huntland, TN; Lawrenceburg, TN; Lynchburg, TN…

Other NPIs on the same Medicare enrollment 41

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

View all 41

National Provider Directory

National Provider Directory
Part of
Amg Southern Tennessee LLC

Practitioners & affiliated clinicians

Practitioners 7

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": "1348704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529971200000",
    "number": "1841541117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10054 OLD TULLAHOMA RD",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373886122",
            "telephone_number": "931-967-8641",
            "fax_number": "931-455-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10054 OLD TULLAHOMA RD",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "37388",
            "telephone_number": "931-967-8641",
            "fax_number": "931-455-0892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG - SOUTHERN TENNESSEE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMG - SOUTHERN TENNESSEE, LLC",
        "enumeration_date": "2012-09-27",
        "last_updated": "2018-06-26",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "615-920-7780"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1530024",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Physicians of Estill Springs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tullahoma, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; 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.