NPIMap

Organization Active NPI

The University of Memphis

Doing business as Memphis Community Health Clinic

  • Nurse Practitioner
  • Memphis, TN
National Provider Identifier
1891515995
Registry record updated Feb 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
THE UNIVERSITY OF MEMPHIS
Doing business as
Memphis Community Health Clinic
Practice address
4055 N Park Loop Ste 1500
Memphis, TN 38152-4220
Phone
(901) 678-2003
NPI assigned
Oct 14, 2024
Last updated
Feb 12, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
THE UNIVERSITY OF MEMPHISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 12, 2025

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

Authorized official

Name
Dr. Bradley R Harrell, DNP, APRN, ACNP-BCNPI 1710204128
Title
Assistant Dean
Phone
(901) 678-2003

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 9

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X NU
Nursing Care Agency 251J00000X NU
Clinic/Center 261Q00000X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Multi-Specialty Clinic/Center 261QM1300X NU
Primary Care Clinic/Center 261QP2300X NU
Research Clinic/Center 261QR1100X NU
Student Health Clinic/Center 261QS1000X NU
Nurse Practitioner 363L00000X NU Primary

Addresses

Primary practice location

4055 N Park Loop Ste 1500
Memphis, TN 38152-4220

Mailing address

4055 N Park Loop Ste 2502
Memphis, TN 38152-4220
Phone (901) 678-2003

Other names 1

  • Memphis Community Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250418001122 TN Part B Supplier - Clinic/Group Practice 9032373956 Receives reassigned benefits from 1 practitioner
Practice locations: Memphis, TN

Other NPIs with the same Medicare PAC ID 1

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

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
44D2323249Memphis Community Health Clinic4055 North Park Loop, Suite 1500, Memphis, TN 38152Certificate of waiverMay 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
The University of Memphis5 organizations share this tax ID, including this one
Part of
The University of Memphis

Other organizations with this tax ID 4

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

Locations

4055 N Park Loop
Ste 1000
Memphis, TN 38152
Phone (320) 990-1678

4055 N Park Loop
Ste 1500
Memphis, TN 38152
Phone (901) 678-2003

4055 N Park Loop
Ste 2502
Memphis, TN 38152

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1728864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739318400000",
    "number": "1891515995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 N PARK LOOP STE 2502",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381524220",
            "telephone_number": "901-678-2003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 N PARK LOOP STE 1500",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381524220",
            "telephone_number": "901-678-2003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE UNIVERSITY OF MEMPHIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE UNIVERSITY OF MEMPHIS",
        "enumeration_date": "2024-10-14",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A",
        "authorized_official_last_name": "HARRELL",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ASSISTANT DEAN",
        "authorized_official_telephone_number": "901-678-2003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, APRN, ACNP-BC"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Research",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memphis Community Health Clinic",
            "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 Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.