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TENNESSEE PARK MD
NPI 1619504388
Student in an Organized Health Care Education/Training Program in Charlottesville, VA

Active since March 24, 2020PECOS EnrolledAccepts Medicare Assignment
1215 LEE ST, MAIL STOP 800699, CHARLOTTESVILLE, VA 22908(434) 924-8485(434) 982-4118 Get Directions Write a Review

NPPES record last updated: March 24, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Tennessee Park Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TENNESSEE PARK MD (NPI 1619504388) is an individual student in an organized health care education/training program in Charlottesville, Virginia and active in the NPI registry since March 2020. He is enrolled in Medicare PECOS, is affiliated with Mary Washington Hospital, and is a graduate of University Of South Florida College Of Medicine (2020).

NPPES Registry Identity

NPI1619504388
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameTENNESSEE PARKCredential: MD
Location Address1215 LEE ST, MAIL STOP 800699Charlottesville, VA 22908-0816
Mailing Address1215 Lee St, Mail Stop 800699Charlottesville, VA 22908-0816 · (434) 924-8485 · Fax (434) 982-4118
Phone(434) 924-8485
Fax(434) 982-4118
Sole ProprietorNo
Medical School CMSUniversity Of South Florida College Of MedicineGraduated 2020
Enumeration DateMarch 24, 2020
NPPES CertifiedMarch 24, 2020
✔ NPI 1619504388 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1215 LEE ST, Charlottesville, VA 22908
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Tennessee Park Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4981029832
PECOS Enrollment IDI20230912000309
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Emergency department visit with high level of medical decision making 99285
An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.
410 services399 patients
Emergency department visit with moderate level of medical decision making 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
135 services135 patients
Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
105 services103 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Mary Washington Hospital

Acute Care Hospitals · Fredericksburg, VA
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number490022
Location1001 Sam Perry BoulevardFredericksburg, VA 22401 · Fredericksburg City County
Emergency services Birthing friendly

Stafford Hospital, LLC

Acute Care Hospitals · Stafford, VA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number490140
Location101 Hospital Center BoulevardStafford, VA 22554 · Stafford County
Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NORMA BRANHAM R.N., N.P.
Nurse Practitioner
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 924-2047
FARNAZ M GAZONI MD
Anesthesiology
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 924-2283
MARGARET K. SANDE M.D.
Emergency Medicine
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 924-2231
KATHERINE T, FORKIN M.D.
Anesthesiology
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 924-2283
AMBER N. INOFUENTES M.D.
Hospitalist
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 243-4288
JOY R MILLER PNP
Nurse Practitioner (Pediatrics)
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 243-2617
DR. DARREN GUFFEY M.D.
Dermatology
1215 LEE ST, BOX 800744
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 924-1931
SETH MORRISON MD
Pediatrics (Pediatric Gastroenterology)
1215 LEE ST
CHARLOTTESVILLE, VA 22908
Charlottesville City (434) 924-3627

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tennessee Park's NPI number?

The NPI number for Tennessee Park is 1619504388. It was assigned to this individual provider in the NPPES registry on March 24, 2020.

Where is Tennessee Park located?

Tennessee Park practices at 1215 Lee St Mail Stop 800699, Charlottesville, VA 22908. The listed phone number is (434) 924-8485.

What is Tennessee Park's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Tennessee Park enrolled in Medicare?

Yes. Tennessee Park is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Tennessee Park affiliated with any hospitals?

According to CMS data, Tennessee Park is affiliated with Mary Washington Hospital and Stafford Hospital, LLC.

When was this NPI record last updated?

The NPPES record for Tennessee Park was last updated on March 24, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.