PREVENTIVE INTERNAL MEDICINE GROUP PLLC (NPI# 1548371784) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548371784 |
| Entity Type | Organization |
| Organization Name | PREVENTIVE INTERNAL MEDICINE GROUP PLLC |
| Practice Address |
6005 Park Ave Suite 728b Memphis TN 38119 |
| Practice Telephone | 9017619097 |
| Practice Fax Number | 9016827635 |
| Mailing Telephone | 9017619097 |
| Mailing Fax Number | 9016827635 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | GORDON JEROME KRAUS (PARTNER) |
| Authorized Official Telephone | 9017619097 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RAILROAD MEDICARE | CB4812 | 01 |
| Street Address |
6005 PARK AVE SUITE 728B |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821091612 | Eugene J. Spiotta Jr. | Internal Medicine | 6005 Park Ave, Ste 200, Memphis, TN 38119-5212 | 2005-05-24 |
| 1013525187 | Kershaw Primary Care and Weight Loss | Nurse Practitioner | 6005 Park Ave, Memphis, TN 38119-5202 | 2020-07-15 |
| 1023552387 | Mary Hamm | Social Worker | 6005 Park Ave, Memphis, TN 38119-5202 | 2016-12-06 |
| 1427501147 | Michelle Colette Gammill | Physician Assistant | 6005 Park Ave, Suite 500b, Memphis, TN 38119-5202 | 2016-07-28 |
| 1659732063 | Jennifer Wineland Rich | Nurse Practitioner | 6005 Park Ave, Memphis, TN 38119-5202 | 2016-03-11 |
| 1033581764 | Sue Stovall | Registered Nurse | 6005 Park Ave, Suite 630b, Memphis, TN 38119-5202 | 2015-10-21 |
| 1497121990 | Vogelfanger and Struble Clinic, Pllc | Nurse Practitioner | 6005 Park Ave, Unit 630b, Memphis, TN 38119-5202 | 2015-08-19 |
| 1801297551 | Robert W Greene Jr Md PC | Physical Medicine & Rehabilitation | 6005 Park Ave, Suite 112, Memphis, TN 38119-5202 | 2014-09-12 |
| 1780085787 | Isaac John M.d., P.c | Pediatrics | 6005 Park Ave, Memphis, TN 38119-5202 | 2014-09-09 |
| 1093131401 | Mid South Pain and Anesthesia Clinic | Durable Medical Equipment & Medical Supplies | 6005 Park Ave, Suite 502, Memphis, TN 38119-5202 | 2014-03-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417469628 | Jojuan Fullwiley | Behavioral Analyst | 6685 Quince Rd Ste 116, Memphis, TN 38119 | 2017-10-27 |
| 1336675297 | Jill Budynas Depriest | Counselor | 5583 Murray Ave Ste 203, Memphis, TN 38119 | 2017-05-11 |
| 1396279220 | Glen Matthew Stamps Jr. | Counselor | 5583 Murray Ave Ste 207, Memphis, TN 38119 | 2017-04-18 |
| 1598117442 | Hazel Aberdeen | Chiropractor | 1911 Memphis Tennessee, Memphis, TN 38119 | 2016-07-04 |
| 1831569060 | E-c-t Non Emergency Medical Transport | Non-emergency Medical Transport (VAN) | 6869 Woodlake Dr, Memphis, TN 38119 | 2015-09-30 |
| 1053781617 | Astrid Roman | Dietitian, Registered | 8020 Hillside Cv, Memphis, MS 38119 | 2015-09-25 |
| 1467857664 | Allan Jacob Katz | Counselor | 5668 Rex Rd, Suite 104, Memphis, TN 38119 | 2014-10-30 |
| 1962836015 | Judy Ann Harrick | Acupuncturist | 5575 Poplar Ave., #702, Memphis, TN 38119 | 2013-08-26 |
| 1366791949 | Jennifer Denyes Bidelman | Audiologist | 5625 Poplar Avenue, Memphis, TN 38119 | 2012-08-29 |
| 1578833620 | Elizabeth Mary Dion-douglass | Pharmacist | 2891 Kirby Parkway, Memphis, TN 38119 | 2012-01-06 |
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| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427546415 | Christopher Nelson | Internal Medicine | 5100 Poplar Ave Ste 512, Memphis, TN 38137-0500 | 2018-04-25 |
| 1356797898 | Shwetapadma Sahu | Internal Medicine | 109 N Main St Apt 811, Memphis, TN 38103-5019 | 2016-05-13 |
| 1780030619 | Lamia Aljundi | Internal Medicine | 956 Court Avenue Suite H316b, Memphis, TN 38163-2148 | 2016-05-10 |
| 1437513439 | Highland Medical Corp | Internal Medicine | 3445 Poplar Ave Ste 13, Memphis, TN 38111-4667 | 2016-04-06 |
| 1760845994 | Anthony Selase Sallar | Internal Medicine | 920 Madison Ave Ste 300a, Memphis, TN 38103-3472 | 2016-04-04 |
| 1306218235 | Amp Medical Management, LLC | Internal Medicine | 1102 Brookfield Rd, Ste 102, Memphis, TN 38119-3826 | 2015-10-30 |
| 1245636596 | Jiten P Kothadia | Internal Medicine | 1265 Union Avenue 4 Shorb Tower, Memphis, TN 38104-4418 | 2014-11-14 |
| 1841614252 | Saurav Acharya | Internal Medicine | 956 Court Avenue G326 Coleman Building, Memphis, TN 38163-2857 | 2014-02-06 |
| 1396182705 | John W Fowler Jr. Md Pllc | Internal Medicine | 184 Colonial Rd, Memphis, TN 38117-3206 | 2013-05-24 |
| 1497198865 | Jeremy Scott Avila | Internal Medicine | 6799 Great Oaks Rd Ste 105, Memphis, TN 38138-2572 | 2013-04-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.