Abundant Healthcare Clinic LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

ABUNDANT HEALTHCARE CLINIC LLC

Practice address

130 Serral Dr
Greeneville, TN 37745-3074

Phone

(423) 638-7499

NPI assigned

Jul 11, 2018

Organization subpart

No

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

Authorized official

Name

Merlon Kent Craft

Title

Evp/Cfo

Phone

(318) 949-5515

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23463/brand/1/csg/1/fhir/r4

Practitioners 5

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

• Sadia Majid Dar, MD

  • Family Medicine Physician
  • Smyrna, TN
  • NPI 1326115577

  TN

  Medicare reassignment NPD
• Saprina F Fender, ANP

  • Family Nurse Practitioner
  • Greeneville, TN
  • NPI 1861555815

  TN

  Medicare reassignment NPD
• Gerard K Mazza, MD

  • Family Medicine Physician
  • Cleveland, TN
  • NPI 1568504918

  TN

  Medicare reassignment NPD
• Crystal M Weems, FNP-C

  • Family Nurse Practitioner
  • Greeneville, TN
  • NPI 1225517253

  TN

  Medicare reassignment NPD
• Brandy N White, FNP-C

  • Family Nurse Practitioner
  • Greeneville, TN
  • NPI 1336704485
  NPD

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

{
    "created_epoch": "1531267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1982180113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 HIGHWAY 80",
            "city": "HAUGHTON",
            "state": "LA",
            "postal_code": "710379488",
            "telephone_number": "318-949-5515",
            "fax_number": "318-949-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 SERRAL DR",
            "city": "GREENEVILLE",
            "state": "TN",
            "postal_code": "377453074",
            "telephone_number": "423-638-7499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6050 Dana Way Ste 200",
            "address_purpose": "LOCATION",
            "city": "Antioch",
            "state": "TN",
            "postal_code": "370133224",
            "country_code": "US",
            "telephone_number": "615-641-2292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ABUNDANT HEALTHCARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-11",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "CRAFT",
        "authorized_official_first_name": "MERLON",
        "authorized_official_middle_name": "KENT",
        "authorized_official_title_or_position": "EVP/CFO",
        "authorized_official_telephone_number": "318-949-5515"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Service Clinic/Center in Greeneville, TN
• Providers in Greeneville, TN by specialty
• Health Service Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.