NPIMap

Organization Active NPI

Dedicated Physicians Group of Tennessee, PLLC

  • Non-Pharmacy Dispensing Site
  • Memphis, TN
National Provider Identifier
1891328993
Registry record updated Dec 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
DEDICATED PHYSICIANS GROUP OF TENNESSEE, PLLC
Practice address
1056 E Raines Rd
Memphis, TN 38116-6337
Phone
(901) 300-5777
NPI assigned
Feb 17, 2020
Organization subpart
Yes
Parent organization
DEDICATED PHYSICIANS GROUP OF TENNESSEE, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 24, 2020

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

Authorized official

Name
Mary Chen
Title
Exec. Officer
Phone
(305) 628-6117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

1056 E Raines Rd
Memphis, TN 38116-6337

Mailing address

1395 NW 167TH St
Miami, FL 33169-5710
Phone (305) 628-6117

Other names 1

  • Dedicated Senior Medical Center Graceland Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2188078Dedicated Senior Medical Center - Graceland1056 East Raines Road, Memphis, TN 38116Certificate of waiverJul 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
Dedicated Physicians Group of Tennessee PLLC6 organizations share this tax ID, including this one
Part of
Dedicated Physicians Group of Tennessee PLLC

Other organizations with this tax ID 5

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": "1581897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608768000000",
    "number": "1891328993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "305-628-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1056 E RAINES RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381166337",
            "telephone_number": "901-300-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEDICATED PHYSICIANS GROUP OF TENNESSEE, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEDICATED PHYSICIANS GROUP OF TENNESSEE, PLLC",
        "enumeration_date": "2020-02-17",
        "last_updated": "2020-12-24",
        "certification_date": "2020-12-24",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "EXEC. OFFICER",
        "authorized_official_telephone_number": "305-628-6117"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dedicated Senior Medical Center Graceland",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dedicated Senior Medical Center Graceland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.