NPIMap

Organization Active NPI

Crossroads Urgent Care PLLC

Doing business as Urgent Team

  • Rural Health Clinic/Center
  • Cookeville, TN
National Provider Identifier
1114650819
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CROSSROADS URGENT CARE PLLC
Doing business as
Urgent Team
Practice address
650 S Jefferson Ave Ste 101
Cookeville, TN 38501-4022
Phone
(931) 303-0958
Fax
(931) 854-1545
NPI assigned
Jul 8, 2022
Last updated
Mar 26, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

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

Authorized official

Name
Stephanie Hicks
Title
Controller
Phone
(615) 988-2004

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Primary Care Clinic/Center 261QP2300X NU
Rural Health Clinic/Center 261QR1300X NU Primary
Urgent Care Clinic/Center 261QU0200X NU
Physician Assistant 363A00000X NU
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

650 S Jefferson Ave Ste 101
Cookeville, TN 38501-4022

Mailing address

30 Burton Hills Blvd Ste 175
Nashville, TN 37215-6403
Phone (615) 864-8709

Other names 1

  • Urgent Team Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220825000499 TN Part A Provider - Rural Health Clinic 8325117484 Practice locations: Cookeville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114650819. Details of each certification follow.

Rural health clinic certification: CCN 883930

Legal name
CROSSROADS URGENT CARE PLLC
Doing business as
ASCENSION SAINT THOMAS URGENT CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 17, 2022
Last certification
Nov 17, 2022
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jul 26, 2006 in TN
Enrollment address
650 S Jefferson Ave
Ste 101
Cookeville, TN 38501-4022

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2157477Crossroads Urgent Care, PLLC650 S Jefferson Ave Suite 101, Cookeville, TN 38501Certificate of waiverNov 5, 2026

National Provider Directory

National Provider Directory
Tax ID family
Crossroads Urgent Care PLLC40 organizations share this tax ID, including this one

Other organizations with this tax ID 39

Organizations that report the same tax identification number in the National Provider Directory.

View all 39

Locations

650 S Jefferson Ave
Ste 101
Cookeville, TN 38501
Phone (931) 303-0958

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Stephanie Hicks Individual Corporate DirectorController Dec 3, 2024
W-2 Managing EmployeeController Dec 3, 2024
Rudy L Blank Individual Corporate DirectorCfo Oct 1, 2017
Kaylan Kirby Individual W-2 Managing EmployeeBilling Manager Oct 1, 2017
William E Meadows Individual 5% Or Greater Direct Ownership InterestMD/Owner May 16, 2016
Crystal Gibson Individual W-2 Managing EmployeeCredentialing Manager Jun 6, 2022

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1657238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1114650819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 BURTON HILLS BLVD STE 175",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156403",
            "telephone_number": "615-864-8709",
            "fax_number": "615-301-6558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 S JEFFERSON AVE STE 101",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385014022",
            "telephone_number": "931-303-0958",
            "fax_number": "931-854-1545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS URGENT CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-08",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "615-988-2004"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Urgent Team",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Urgent Team",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.