NPIMap

Organization Active NPI

Collierville Orthopedics and

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Collierville, TN
National Provider Identifier
1003855420
Registry record updated Nov 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
COLLIERVILLE ORTHOPEDICS AND
Practice address
472 W Poplar Ave Ste 200
Collierville, TN 38017-2780
Phone
(901) 850-1150
Fax
(901) 850-1102
NPI assigned
Jun 5, 2006
Last updated
Nov 1, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2017

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

Authorized official

Name
Dede Coke
Title
Office Manager
Phone
(901) 850-1150

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X NU Primary
Orthopedic Physical Therapist 2251X0800X 1717 TN

Addresses

Primary practice location

472 W Poplar Ave Ste 200
Collierville, TN 38017-2780

Mailing address

PO Box 9616
Belfast, ME 04915-9616
Phone (901) 850-1150

Other identifiers 3

IdentifierTypeStateIssuer
03404737MedicaidMS
3711730MedicaidTN
CK8118OtherRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2699/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509494400000",
    "number": "1003855420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9616",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049159616",
            "telephone_number": "901-850-1150",
            "fax_number": "901-850-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "472 W POPLAR AVE STE 200",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380172780",
            "telephone_number": "901-850-1150",
            "fax_number": "901-850-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIERVILLE ORTHOPEDICS AND",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-05",
        "last_updated": "2017-11-01",
        "status": "A",
        "authorized_official_last_name": "COKE",
        "authorized_official_first_name": "DEDE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "901-850-1150"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "TN",
            "license": "1717",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03404737",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3711730",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CK8118",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Collierville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.