NPIMap

Organization Active NPI

Scenic City Rheumatology, PLLC

  • Specialist
  • Chattanooga, TN
National Provider Identifier
1871647800
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
16562 Issued in TN
Legal business name
SCENIC CITY RHEUMATOLOGY, PLLC
Practice address
6145 Shallowford Rd
Ste 102
Chattanooga, TN 37421-7808
Phone
(423) 893-6890
Fax
(423) 648-1115
NPI assigned
Jan 23, 2007
Last updated
Jun 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

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

Authorized official

Name
Dr. Richard W Brackett, MDNPI 1568564672
Title
Owner
Phone
(423) 893-6890

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 16562 TN Primary

Addresses

Primary practice location

6145 Shallowford Rd
Ste 102
Chattanooga, TN 37421-7808

Mailing address

6145 Shallowford Rd
Ste 102
Chattanooga, TN 37421-7808
Phone (423) 893-6890

Other practice location 1

2440 Julian Dr NE
Cleveland, TN 37312-5433
Phone (423) 250-5551

Other identifiers 2

IdentifierTypeStateIssuer
3731246MedicaidTN
4110715OtherTNBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050923000757 TN Part B Supplier - Clinic/Group Practice 4183658693 Receives reassigned benefits from 8 practitioners
Practice locations: Chattanooga, TN; Cleveland, TN

National Provider Directory

National Provider Directory

Locations

3770 Ocoee Pl NW
Ste 100
Cleveland, TN 37312
Phone (423) 250-5551

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": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686268800000",
    "number": "1871647800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6145 SHALLOWFORD RD",
            "address_2": "STE 102",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374217808",
            "telephone_number": "423-893-6890",
            "fax_number": "423-648-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6145 SHALLOWFORD RD",
            "address_2": "STE 102",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374217808",
            "telephone_number": "423-893-6890",
            "fax_number": "423-648-1115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2440 Julian Dr NE",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "TN",
            "postal_code": "373125433",
            "country_code": "US",
            "telephone_number": "423-250-5551",
            "fax_number": "423-250-5556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SCENIC CITY RHEUMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A",
        "authorized_official_last_name": "BRACKETT",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-893-6890",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TN",
            "license": "16562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3731246",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4110715",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; 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.