MEDICARE: DR. ERICH B GROOS JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	23890	TN
2	207W00000X	Ophthalmology Physician	MD23890	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	180019311	OTHER	TN	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00001364	OTHER	TN	NHC HEALTH BENEFITS PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4243673	OTHER	TN	AETNA
5	2616397006	OTHER	TN	CIGNA
6	F01637	OTHER	TN	HEALTHSPRING
7	3126357	OTHER	TN	BCBS
8	3126357	OTHER	TN	CENTRAL STATES
9	621745543	OTHER	TN	HUMANA
10	621745543000	OTHER	TN	PRUDENTIAL
11	OP34694	OTHER	TN	UNITED HEALTHCARE
12	F01637	OTHER	TN	STERLING CLAIMS
13	3126357	OTHER	TN	TENNCARE SELECT

General Provider Information

NPI Number	:	1720084601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICH B GROOS JR. M.D.

Provider Business Mailing Address
First Line	:	2400 PATTERSON ST
Second Line	:	SUITE 201
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1562
Country	:	US
Telephone Number	:	615-320-7200
Fax Number	:	615-320-7203

Provider Business Practice Location Address
First Line	:	2400 PATTERSON ST
Second Line	:	SUITE 201
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1562
Country	:	US
Telephone Number	:	615-320-7200
Fax Number	:	615-320-7203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	05/19/2020

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