NPIMap

Organization Active NPI

Privia Medical Group Tennessee LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • White House, TN
National Provider Identifier
1851058879
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
PRIVIA MEDICAL GROUP TENNESSEE LLC
Practice address
707 Highway 76
White House, TN 37188-9208
Phone
(571) 982-6636
NPI assigned
Nov 24, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Authorized official

Name
Mary Roller
Title
Associate Director/Enrollment
Phone
(770) 312-5226

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X Primary

Addresses

Primary practice location

707 Highway 76
White House, TN 37188-9208

Mailing address

950 N Glebe Rd Ste 700
Arlington, VA 22203-4173
Phone (571) 982-6636

Other names 1

  • Sports Orthro Urgent Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221013001759 TN DME Supplier - Physician - Orthopedic/Orthopedic Surgery 0547667552 Practice locations: White House, TN

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Privia Medical Group Tennessee LLC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1637712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657670400000",
    "number": "1851058879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N GLEBE RD STE 700",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222034173",
            "telephone_number": "571-982-6636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 HIGHWAY 76",
            "city": "WHITE HOUSE",
            "state": "TN",
            "postal_code": "371889208",
            "telephone_number": "571-982-6636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP TENNESSEE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-24",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A",
        "authorized_official_last_name": "ROLLER",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR/ENROLLMENT",
        "authorized_official_telephone_number": "770-312-5226"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sports Orthro Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sports Orthro Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in White House, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; 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.