Individual provider Active NPI

Christopher L. Nelson, PA

  • Surgical Physician Assistant
  • Cookeville, TN
National Provider Identifier
1114911971
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
2974 Issued in TN
Practice address
222 W 4TH St Ste 201
Cookeville, TN 38501-2413
Phone
(931) 783-4269
Fax
(931) 372-0401
NPI assigned
Sep 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 085000452 IL
Physician Assistant 363A00000X 2974 TN
Surgical Physician Assistant 363AS0400X 085000452 IL
Surgical Physician Assistant 363AS0400X 2974 TN Primary

Addresses

Primary practice location

222 W 4TH St Ste 201
Cookeville, TN 38501-2413

Mailing address

140 W 7TH St
Cookeville, TN 38501-1726
Phone (931) 783-5582

Other identifiers 1

IdentifierTypeStateIssuer
Q020561MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160415001471 TN Practitioner - Physician Assistant 7911901285 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cookeville Regional Medical Group IncGroup PAC ID 8325092638, 54 clinicians

Practice addresses (Care Compare)

1 Medical Ctr Blvd
Cookeville, TN 38501-4294
Phone (931) 783-5857

100 W 4TH St
Suite 350
Cookeville, TN 38501-4225
Phone (931) 783-2753

Hospital & facility affiliations

  • Cookeville Regional Medical Center Hospital, Cookeville, TN, CCN 440059

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2974TNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Cardiovascular & Thoracic Surgery, LTD Cardiovascular Disease Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: christopher.nelson.1@10383.direct.athenahealth.com
  • Direct secure messaging: cnelsonmd311087@carlehiedirect.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746057600000",
    "number": "1114911971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 W 7TH ST",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385011726",
            "telephone_number": "931-783-5582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W 4TH ST STE 201",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012413",
            "telephone_number": "931-783-4269",
            "fax_number": "931-372-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "CHRISTOPHER",
        "middle_name": "L.",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "085000452",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2974",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085000452",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "2974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q020561",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.