NPIMap

Organization Active NPI

Tennessee Innovative Medical Services PLLC

  • Vascular & Interventional Radiology Physician
  • Knoxville, TN
National Provider Identifier
1114285400
Registry record updated Jul 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
TENNESSEE INNOVATIVE MEDICAL SERVICES PLLC
Practice address
116 Concord Rd
Ste 400
Knoxville, TN 37934-2940
Phone
(865) 777-6880
Fax
(865) 777-6881
NPI assigned
Apr 25, 2012
Last updated
Jul 2, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2012

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

Authorized official

Name
Jason G. Funderburk, MDNPI 1104883966
Title
Sole Owner
Phone
(865) 777-6880

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X TN Primary

Addresses

Primary practice location

116 Concord Rd
Ste 400
Knoxville, TN 37934-2940

Mailing address

194 Market Place Blvd
Knoxville, TN 37922-2337
Phone (865) 560-8787

Other identifiers 1

IdentifierTypeStateIssuer
1527902MedicaidTN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341187200000",
    "number": "1114285400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "194 MARKET PLACE BLVD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379222337",
            "telephone_number": "865-560-8787",
            "fax_number": "865-560-8784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 CONCORD RD",
            "address_2": "STE 400",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379342940",
            "telephone_number": "865-777-6880",
            "fax_number": "865-777-6881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE INNOVATIVE MEDICAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-25",
        "last_updated": "2012-07-02",
        "status": "A",
        "authorized_official_last_name": "FUNDERBURK",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "865-777-6880",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1527902",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; 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.