NPIMap

Individual provider Active NPI

Jacqueline Denise Milam, MD

  • Internal Medicine Physician
  • Clarksville, TN
National Provider Identifier
1972584993
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
21903 Issued in TN
Practice address
490 Dunlop LN
Clarksville, TN 37040-5007
Phone
(931) 245-8300
Fax
(931) 245-8360
NPI assigned
Nov 8, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 21903 TN Primary

Addresses

Primary practice location

490 Dunlop LN
Clarksville, TN 37040-5007

Mailing address

PO Box 3799
Clarksville, TN 37043-3799
Phone (931) 245-7000

Other identifiers 1

IdentifierTypeStateIssuer
Q004447MedicaidTN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jacqueline.milam.2@7977.direct.athenahealth.com Direct Premier Medical Group PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090115000730 TN Practitioner - Internal Medicine 1759471576 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Louisville School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Premier Medical Group PCGroup PAC ID 9739084088, 46 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

490 Dunlop LN
Clarksville, TN 37040-5007
Phone (931) 245-7000

980 Professional Park Dr
Suite D
Clarksville, TN 37040-5251
Phone (931) 221-9967

Hospital & facility affiliations

  • Suncrest Home Health Home health agency, Clarksville, TN, CCN 447298
  • Tennessee Quality Care - Home Health Home health agency, Parsons, TN, CCN 447402
  • Amedisys Home Health Home health agency, Brentwood, TN, CCN 447107
  • Vanderbilt Clarksville Hospital Hospital, Clarksville, TN, CCN 440035
  • Vanderbilt University Medical Center Hospital, Nashville, TN, CCN 440039
  • Ascension Saint Thomas Hospital Hospital, Nashville, TN, CCN 440082
  • Tristar Centennial Medical Center Hospital, Nashville, TN, CCN 440161
  • Tristar Skyline Medical Center Hospital, Nashville, TN, CCN 440006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
21903TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Medical Group PC Internal Medicine CurrentSince Dec 1, 2000 Accepting new patients
Tennessee Heart and Lung Institute PLC Past Accepting new patients
Clarksville Physician Services, LLC Past Accepting new patients
Bedford Radiology, PLLC Past Accepting new patients

Locations

651 Dunlop Ln
Clarksville, TN 37040
Phone (931) 502-1000

2831 Wilma Rudolph Blvd
Clarksville, TN 37040
Phone (931) 245-8600

1832 Memorial Dr
Clarksville, TN 37043
Phone (931) 645-3552

Interoperability endpoints

  • Direct secure messaging: jacqueline.milam.2@7977.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1972584993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3799",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370433799",
            "telephone_number": "931-245-7000",
            "fax_number": "931-245-7068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 DUNLOP LN",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370405007",
            "telephone_number": "931-245-8300",
            "fax_number": "931-245-8360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILAM",
        "first_name": "JACQUELINE",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-08",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "21903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q004447",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacqueline.milam.2@7977.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "Premier Medical Group PC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "490 Dunlop Ln",
            "city": "Clarksville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "370405007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

Verify at the official NPI Registry.