Grace Pediatrics PLLC
Organization Active NPI Pediatrics Physician · Pleasant View, TN
NPI 1992553689 · NPPES record last updated May 8, 2024
Key facts
- NPI
- 1992553689
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 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
- Organization subpart
- No
Authorized official
- Name
- Angela Stout
- Title
- Office Manager
- Phone
- (615) 459-5252
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 2
Practitioners 16
-
Annie Rose Hogan, CPNP-PC, MSN
-
Mark D Hughes, MD
-
Chandler Washburn, PNP
-
Tanzila Arzu Bashar, M.D.
-
Sarah McClure Hill, CPNP-PC
-
Frances Llewellyn Lavin, CPNP-PC
-
Emily Frazier Morris, APRN
-
Sarah-Jo Stimpson, M.D.
-
Alicia Rose Webb, PNP
-
Lisa C Wood, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2046132 | Grace Pediatrics, PLLC | Certificate of waiver | Jul 24, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
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
- LLC · Proprietary
- Enrollment address
- 238 Centre St
Ste 100
Pleasant View, TN 37146-7081
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Samori O Cummings |
5% Or Greater Direct Ownership Interest |
Aug 12, 2024 | 100% |
| Corporate Officer |
Aug 12, 2024 | 100% | |
| W-2 Managing Employee |
Aug 12, 2024 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250228001581 | TN | Part a Provider - Rural Health Clinic | 6305976002 | Practice locations: Pleasant View, TN |
National Provider Directory
- Tax ID family
- Grace Pediatrics PLLC
Locations
238 Centre St
Ste 100
Pleasant View, TN 37146
Phone (615) 746-4040
699 President Pl
Ste 402
Smyrna, TN 37167
Phone (615) 459-5252
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes |
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
Other providers in Pleasant View, TN
- Charna Green Evans
- Joann A Ferland
- Christopher David Fleming
- Fred Nordquist, MD, PC
- Freedom Access LLC
- Abigail Leigh Greene
- Ariel Griffin
- Thomas F Hadley
- Toniann Hart
- Emily Harvison
All providers in Pleasant View, TN · Pediatrics 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 May 8, 2024. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.