Organization Active NPI

Interventional Diabetes Center LLC 3

  • Podiatrist
  • Memphis, TN
National Provider Identifier
1881483733
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
INTERVENTIONAL DIABETES CENTER LLC 3
Practice address
5362 Estate Office Dr Ste 1
Memphis, TN 38119-3630
Phone
(901) 791-1711
NPI assigned
May 6, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2025

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

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

5362 Estate Office Dr Ste 1
Memphis, TN 38119-3630

Mailing address

5362 Estate Office Dr Ste 1
Memphis, TN 38119-3630
Phone (901) 791-1711

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250619001524 TN Part B Supplier - Clinic/Group Practice 1658882212 Receives reassigned benefits from 4 practitioners
Practice locations: Memphis, TN

National Provider Directory

National Provider Directory

Locations

5362 Estate Office Dr
Memphis, TN 38119

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1746489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746489600000",
    "number": "1881483733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5362 ESTATE OFFICE DR STE 1",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381193630",
            "telephone_number": "901-791-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5362 ESTATE OFFICE DR STE 1",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381193630",
            "telephone_number": "901-791-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL DIABETES CENTER LLC 3",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-06",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "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": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.