NPIMap

Organization Active NPI

Grace Pediatrics PLLC

  • Pediatrics Physician
  • Pleasant View, TN
National Provider Identifier
1992553689
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
GRACE PEDIATRICS PLLC
Practice address
238 Centre St Ste 100
Pleasant View, TN 37146-7081
Phone
(615) 746-4040
Fax
(615) 746-4044
NPI assigned
May 8, 2024
Last updated
May 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Authorized official

Name
Angela Stout
Title
Office Manager
Phone
(615) 459-5252

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

238 Centre St Ste 100
Pleasant View, TN 37146-7081

Mailing address

1335 Rock Springs Rd
Smyrna, TN 37167-6108
Phone (615) 459-5252

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250228001581 TN Part A Provider - Rural Health Clinic 6305976002 Practice locations: Pleasant View, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992553689. Details of each certification follow.

Rural health clinic certification: CCN 888922

Legal name
GRACE PEDIATRICS PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 31, 2025
Last certification
Jan 31, 2025
Ownership / control type
1A
Organization structure
LLCProprietary
Enrollment address
238 Centre St
Ste 100
Pleasant View, TN 37146-7081

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
44D2046132Grace Pediatrics, PLLC238 Centre Street, Suite 100, Pleasant View, TN 37146Certificate of waiverJul 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Grace Pediatrics PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1335 Rock Springs Rd
Smyrna, TN 37167
Phone (615) 459-3232

699 President Pl
Ste 402
Smyrna, TN 37167
Phone (615) 459-5252

990 Elliston Way
Ste 100
Thompsons Station, TN 37179
Phone (615) 550-5221

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Samori O Cummings Individual 5% Or Greater Direct Ownership InterestPresident Aug 12, 2024 100%
Corporate OfficerPresident Aug 12, 2024 100%
W-2 Managing EmployeePresident Aug 12, 2024 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1715126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1992553689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1335 ROCK SPRINGS RD",
            "city": "SMYRNA",
            "state": "TN",
            "postal_code": "371676108",
            "telephone_number": "615-459-5252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 CENTRE ST STE 100",
            "city": "PLEASANT VIEW",
            "state": "TN",
            "postal_code": "371467081",
            "telephone_number": "615-746-4040",
            "fax_number": "615-746-4044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE PEDIATRICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-08",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "615-459-5252"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasant View, TN

Sources for this page

Verify at the official NPI Registry.