Individual provider Active NPI

Dara W Botts, FNP

  • Family Nurse Practitioner
  • Lebanon, TN
National Provider Identifier
1982826004
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
57268 Issued in TN
Practice address
1420 W Baddour Pkwy Ste 200
Lebanon, TN 37087-1510
Phone
(154) 444-4126
Fax
(855) 785-2890
NPI assigned
May 2, 2007
Last updated
Mar 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 57268 TN Primary

Addresses

Primary practice location

1420 W Baddour Pkwy Ste 200
Lebanon, TN 37087-1510

Mailing address

1420 W Baddour Pkwy Ste 200
Lebanon, TN 37087-1510
Phone (154) 444-4126

Other identifiers 1

IdentifierTypeStateIssuer
Q012339MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120815000566 TN Practitioner - Nurse Practitioner 8820244353 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Botts Diabetes and EndocrinologyGroup PAC ID 5496094062, 3 clinicians

Practice addresses (Care Compare)

1420 W Baddour Pkwy
Suite 200
Lebanon, TN 37087-1510
Phone (615) 444-4126

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
57268TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bradshaw Medical Clinic, PC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IAGIAD

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1982826004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 W BADDOUR PKWY STE 200",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370871510",
            "telephone_number": "154-444-4126",
            "fax_number": "855-785-2890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 W BADDOUR PKWY STE 200",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370871510",
            "telephone_number": "154-444-4126",
            "fax_number": "855-785-2890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTTS",
        "first_name": "DARA",
        "middle_name": "W",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "57268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q012339",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, TN

Sources for this page

Verify at the official NPI Registry.