NPIMap

Organization Active NPI

Cookeville Medical Center PC

Doing business as Cookeville Medical Center

  • Family Medicine Physician
  • Cookeville, TN
National Provider Identifier
1013055912
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COOKEVILLE MEDICAL CENTER PC
Doing business as
Cookeville Medical Center
Practice address
225 N Willow Ave
Cookeville, TN 38501-2335
Phone
(931) 528-8899
Fax
(866) 813-8531
NPI assigned
Feb 2, 2007
Last updated
Jun 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Authorized official

Name
Dr. Pushpendra K Jain, M.D.NPI 1689748634
Title
Ceo
Phone
(931) 528-8899

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X NU
Clinical Medical Laboratory 291U00000X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

225 N Willow Ave
Cookeville, TN 38501-2335

Mailing address

225 N Willow Ave
Cookeville, TN 38501-2335
Phone (931) 528-8899

Other practice location 1

319 Broad St
Baxter, TN 38544-5117
Phone (931) 858-2116

Other practice location 2

2546 Windle Community Rd
Cookeville, TN 38506-7941
Phone (931) 498-4880

Other practice location 3

402 E Gore Ave
Gainesboro, TN 38562-9367
Phone (931) 268-6800

Other practice location 4

820 N Main St
Crossville, TN 38555-4024
Phone (931) 250-5230

Other practice location 5

207 E Bockman Way
Sparta, TN 38583-2041
Phone (931) 836-6461

Other identifiers 1

IdentifierTypeStateIssuer
3709492MedicaidTN

Other names 1

  • Cookeville Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031203000055 TN Part B Supplier - Clinic/Group Practice 0143125237 Receives reassigned benefits from 19 practitioners
Practice locations: Cookeville, TN; Baxter, TN; Sparta, TN; Gainesboro, TN; Crossville, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0923891Cookeville Medical Center, PLLC225 N Willow Ave, Suite 3, Cookeville, TN 38501ComplianceJul 8, 2027

National Provider Directory

National Provider Directory

Locations

225 N Willow Ave
Ste 1
Cookeville, TN 38501
Phone (931) 372-8700

229 Interstate Dr
Crossville, TN 38555
Phone (931) 250-2530

1061 W Main St
Livingston, TN 38570
Phone (931) 403-3344

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1013055912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 N WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012335",
            "telephone_number": "931-528-8899",
            "fax_number": "866-813-8531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012335",
            "telephone_number": "931-528-8899",
            "fax_number": "866-813-8531"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "319 Broad St",
            "address_purpose": "LOCATION",
            "city": "Baxter",
            "state": "TN",
            "postal_code": "385445117",
            "country_code": "US",
            "telephone_number": "931-858-2116",
            "fax_number": "833-807-0129",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2546 Windle Community Rd",
            "address_purpose": "LOCATION",
            "city": "Cookeville",
            "state": "TN",
            "postal_code": "385067941",
            "country_code": "US",
            "telephone_number": "931-498-4880",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "402 E Gore Ave",
            "address_purpose": "LOCATION",
            "city": "Gainesboro",
            "state": "TN",
            "postal_code": "385629367",
            "country_code": "US",
            "telephone_number": "931-268-6800",
            "fax_number": "855-736-3491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "820 N Main St",
            "address_purpose": "LOCATION",
            "city": "Crossville",
            "state": "TN",
            "postal_code": "385554024",
            "country_code": "US",
            "telephone_number": "931-250-5230",
            "fax_number": "833-314-0425",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "207 E Bockman Way",
            "address_purpose": "LOCATION",
            "city": "Sparta",
            "state": "TN",
            "postal_code": "385832041",
            "country_code": "US",
            "telephone_number": "931-836-6461",
            "fax_number": "833-623-1827",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COOKEVILLE MEDICAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "JAIN",
        "authorized_official_first_name": "PUSHPENDRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "931-528-8899",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3709492",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cookeville Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cookeville Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.