NPIMap

Organization Active NPI

Crossroads Medical Group, PLLC

  • Clinic/Center
  • White House, TN
National Provider Identifier
1073539607
Registry record updated Jan 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
CROSSROADS MEDICAL GROUP, PLLC
Practice address
491 Sage Rd.
Suite 200
White House, TN 37188-8193
Phone
(615) 672-7122
Fax
(615) 672-8122
NPI assigned
Jul 15, 2006
Last updated
Jan 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2008

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

Authorized official

Name
Mr. Robert E. Ferguson
Title
Executive Director
Phone
(615) 672-7122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

491 Sage Rd.
Suite 200
White House, TN 37188-8193

Mailing address

PO Box 1669
White House, TN 37188-1669
Phone (615) 672-5177

Other names 1

  • Crossroads Medical Group Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071203000721 TN Part B Supplier - Clinic/Group Practice 3779544895 Receives reassigned benefits from 102 practitioners
Practice locations: Greenbrier, TN; White House, TN; Portland, TN; Hendersonville, TN; Goodlettsville, TN

National Provider Directory

National Provider Directory

Locations

900 Conference Dr
Ste 1C
Goodlettsville, TN 37072
Phone (615) 581-9911

3500 N Mount Juliet Rd
Ste 203
Mount Juliet, TN 37122
Phone (615) 444-0465

3500 N Mount Juliet Rd
Ste 201
Mt Juliet, TN 37122
Phone (615) 758-5672

2528 Highway 49 E
#A
Pleasant View, TN 37146
Phone (615) 746-1556

302 N Congress Blvd
Smithville, TN 37166
Phone (615) 597-4395

491 Sage Rd N
Ste 800
White House, TN 37188
Phone (615) 672-4089

Practitioners & affiliated clinicians

Practitioners 103

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 103

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201651200000",
    "number": "1073539607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1669",
            "city": "WHITE HOUSE",
            "state": "TN",
            "postal_code": "371881669",
            "telephone_number": "615-672-5177",
            "fax_number": "615-672-5366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "491 SAGE RD.",
            "address_2": "SUITE 200",
            "city": "WHITE HOUSE",
            "state": "TN",
            "postal_code": "371888193",
            "telephone_number": "615-672-7122",
            "fax_number": "615-672-8122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2008-01-30",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "615-672-7122",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Medical Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in White House, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.