Privia Medical Group Tennessee LLC
Organization Active NPI Sports Medicine (Orthopaedic Surgery) Physician · Clarksville, TN
NPI 1992462923 · NPPES record last updated Jul 13, 2022
Key facts
- NPI
- 1992462923
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X
- Legal business name
- PRIVIA MEDICAL GROUP TENNESSEE LLC
- Practice address
- 1492 Tiny Town Rd Ste A1
Clarksville, TN 37042-7874 - Phone
- (571) 982-6636
- NPI assigned
- Nov 24, 2021
- Organization subpart
- No
Authorized official
- Name
- Mary Roller
- Title
- Associate Director/Enrollment
- Phone
- (770) 312-5226
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 11
Practitioners 141
-
Helana Aiyad, DPT
-
Micah Allison, PT, DPT, CSCS
-
Keaton Allmaras, APRN
-
Angel Dawn Atkins, MSN, APRN, FNP-C
-
Thomas Babcock IV, M.D.
-
Michael Backues, MSM, ATC, PA-C
-
William Bradford Brock, M.D.
-
Michael Andrew Brown, PA-C
-
Dawn Bruni, ANP
-
Sarah Buchanan, FNP
-
Benjamin Alejandro Bueno, PA-C
-
Amy L Busfield, PT
-
Mary Beth Byrd, FNP
-
Haley Camino, PA-C
-
Bryan Dee Chastain, M.D.
-
Melissa Chittum, FNP
-
Nashay N Clemetson, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221010001627 | TN | DME Supplier - Physician - Orthopedic/Orthopedic Surgery | 0547667552 | Practice locations: Clarksville, TN |
National Provider Directory
- Tax ID family
- Privia Medical Group Tennessee LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Orthopaedic Surgery) Physician |
207XX0005X | Yes |
Addresses
Primary practice location
1492 Tiny Town Rd Ste A1
Clarksville, TN 37042-7874
Mailing address
950 N Glebe Rd Ste 700
Arlington, VA 22203-4173
Phone (571) 982-6636
Other names
- Sports Ortho Urgent Care
Other providers in Clarksville, TN
- Primary Care Plus
- William W Prine
- Willie Pringle
- Elizabeth E Pritchett
- Privia Medical Group Tennessee LLC
- Proactive Alliance Therapy & Wellness, PLLC
- Proactive Transportation LLC
- Taiylor Maree Proberts
- Angela Proctor
- Jill T. Proctor
All providers in Clarksville, TN · Sports Medicine (Orthopaedic Surgery) Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.