NPIMap

Organization Active NPI

Crestmoor Surgical Associates PLLC

  • Specialist
  • Nashville, TN
National Provider Identifier
1013266303
Registry record updated Aug 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
36486 Issued in TN
Legal business name
CRESTMOOR SURGICAL ASSOCIATES PLLC
Practice address
2103 Crestmoor Rd
Nashville, TN 37215-2614
Phone
(615) 921-2100
Fax
(615) 921-2101
NPI assigned
Sep 3, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2013

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

Authorized official

Name
Dr. James J Wendel, MD
Title
Owner
Phone
(615) 921-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 36486 TN Primary

Addresses

Primary practice location

2103 Crestmoor Rd
Nashville, TN 37215-2614

Mailing address

2103 Crestmoor Rd
Nashville, TN 37215-2614
Phone (615) 921-2100

Other identifiers 1

IdentifierTypeStateIssuer
1531362MedicaidTN

National Provider Directory

National Provider Directory

Locations

2103 Crestmoor Rd
Nashville, TN 37215
Phone (615) 921-2100

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1346630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375660800000",
    "number": "1013266303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 CRESTMOOR RD",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372152614",
            "telephone_number": "615-921-2100",
            "fax_number": "615-921-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 CRESTMOOR RD",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372152614",
            "telephone_number": "615-921-2100",
            "fax_number": "615-921-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTMOOR SURGICAL ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-03",
        "last_updated": "2013-08-05",
        "status": "A",
        "authorized_official_last_name": "WENDEL",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-921-2100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TN",
            "license": "36486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1531362",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; 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.