Crossville Medical Group PA

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

CROSSVILLE MEDICAL GROUP PA

Practice address

100 Lantana Rd
Suite 202
Crossville, TN 38555-1903

Phone

(931) 484-5141

Fax

(931) 484-5620

NPI assigned

Sep 7, 2006

Last updated

Nov 19, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gary Burton

Title

Administrator

Phone

(931) 484-5141

Specialties & licenses 1

Addresses

Other identifiers 1

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

CLIA laboratory certificates

Locations

Practitioners 23

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.

• Douglas Ray Carpenter Jr., MD

  • Family Medicine Physician
  • Crossville, TN
  • NPI 1093818635
  NPD (past)
• Mark Alan Fox, MD

  • Surgery Physician
  • Crossville, TN
  • NPI 1073526596
  NPD (past)
• Beverly Joan Gardner, PA-C

  • Medical Physician Assistant
  • Crossville, TN
  • NPI 1629089065
  NPD (past)
• Joanna Cher Gibbs, MD

  • Internal Medicine Physician
  • Crossville, TN
  • NPI 1558372862
  NPD (past)
• William Harelson, PA

  • Physician Assistant
  • Crossville, TN
  • NPI 1205871761
  NPD (past)
• Donathan M Ivey, MD

  • Surgery Physician
  • Crossville, TN
  • NPI 1427164557
  NPD (past)
• Mark Keith Lee, MD

  • Internal Medicine Physician
  • Crossville, TN
  • NPI 1528079969
  NPD (past)
• Gary Nelson Morris, MD

  • Internal Medicine Physician
  • Crossville, TN
  • NPI 1982615340
  NPD (past)
• Robert E Nichols, MD

  • Internal Medicine Physician
  • Crossville, TN
  • NPI 1154332591
  NPD (past)
• Elizabeth M Petty, MD

  • Internal Medicine Physician
  • Crossville, TN
  • NPI 1477661361
  NPD (past)
• Johnny Wayne Presley, PAC

  • Medical Physician Assistant
  • Jamestown, TN
  • NPI 1427069749
  NPD (past)
• Steven Pribanich, MD

  • Family Medicine Physician
  • Crossville, TN
  • NPI 1912918343
  NPD (past)

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258588800000",
    "number": "1053414698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 LANTANA RD",
            "address_2": "SUITE 202",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385551903",
            "telephone_number": "931-484-5141",
            "fax_number": "931-484-5620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LANTANA RD",
            "address_2": "SUITE 202",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385551903",
            "telephone_number": "931-484-5141",
            "fax_number": "931-484-5620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSVILLE MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2009-11-19",
        "status": "A",
        "authorized_official_last_name": "BURTON",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "931-484-5141"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3370906",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crossville Dentistry PLLC (Crossville Dentistry)
• Crossville Family Chiropractic PLLC
• Crossville Family Dentistry
• Crossville Family Medicine LLC
• Crossville Gynecology Associates, P.C.
• Crossville Medical Investors, LLC (Life Care Center of Crossville)
• Crossville Medical Oncology PC
• Crossville Orthopaedics & Sports Medicine PLLC
• Crossville TN Opco LLC (WyndRidge Health & Rehab Center)
• Crossville Women's Center PLC

• Multi-Specialty Clinic/Center in Crossville, TN
• Providers in Crossville, TN by specialty
• Multi-Specialty Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.