Tennessee Plateau Oncology PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD21772 Issued in TN

Legal business name

TENNESSEE PLATEAU ONCOLOGY PLLC

Practice address

33 W Adams St
Crossville, TN 38555-4836

Phone

(931) 484-7596

Fax

(931) 484-7597

NPI assigned

Jul 15, 2008

Last updated

Dec 28, 2022By 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

Dr. Dirk C Davidson, M.D.NPI 1659369429

Title

Sole Owner

Phone

(931) 484-7596

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 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 3

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.

• Dirk C Davidson, MD

  • Specialist
  • Crossville, TN
  • NPI 1659369429
  Medicare reassignment Care Compare group NPD Authorized official
• Alasondra Diana Freeborn, PA-C

  • Physician Assistant
  • Crossville, TN
  • NPI 1447965827
  Medicare reassignment Care Compare group
• Margaret D Wilson, FNP

  • Family Nurse Practitioner
  • Crossville, TN
  • NPI 1669548210
  NPD (past)

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

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672185600000",
    "number": "1053575472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 W ADAMS ST",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554836",
            "telephone_number": "931-484-7596",
            "fax_number": "931-484-7597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 W ADAMS ST",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554836",
            "telephone_number": "931-484-7596",
            "fax_number": "931-484-7597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE PLATEAU ONCOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-15",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "DIRK",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "931-484-7596",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TN",
            "license": "MD21772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00102649",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3890077",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Crossville, TN
• Providers in Crossville, TN by specialty
• Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; 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.