Innovative Vascular, PLLC
Organization Active NPI Vascular Surgery Physician · Lenoir City, TN
NPI 1124750765 · NPPES record last updated Oct 27, 2022
Key facts
- NPI
- 1124750765
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Vascular Surgery Physician 2086S0129X
- Legal business name
- INNOVATIVE VASCULAR, PLLC
- Practice address
- 460 Medical Park Dr Ste 104
Lenoir City, TN 37772-5782 - Phone
- (865) 562-3232
- NPI assigned
- Jun 30, 2022
- Organization subpart
- No
Authorized official
- Name
- Chris Pollock, MD
- Title
- MD
- Phone
- (865) 562-3232
Member organizations 1
Practitioners 7
-
Christopher W. Pollock, M.D.
-
Amber Lea Ridner, FNP-BC
-
David W Drum, PA-C
-
Matthew Sean Scanlon, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220901000458 | TN | Part B Supplier - Clinic/Group Practice | 9335523802 |
Receives reassigned benefits from 7 practitioners Practice locations: Lenoir City, TN |
National Provider Directory
Locations
460 Medical Park Dr
Ste 104105
Lenoir City, TN 37772
7557 Dannaher Dr
Ste 210
Powell, TN 37849
Phone (865) 512-1291
Interoperability endpoints
- amberridner@ivpllc.allscriptsdirect.net
- christopherpollock@ivpllc.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician |
2086S0129X | Yes |
Addresses
Primary practice location
460 Medical Park Dr Ste 104
Lenoir City, TN 37772-5782
Mailing address
1908 Oakleigh Way
Knoxville, TN 37919-8995
NPI Registry JSON
{
"created_epoch": "1656547200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1666828800000",
"number": "1124750765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1908 OAKLEIGH WAY",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379198995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "460 MEDICAL PARK DR STE 104",
"city": "LENOIR CITY",
"state": "TN",
"postal_code": "377725782",
"telephone_number": "865-562-3232"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INNOVATIVE VASCULAR, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-06-30",
"last_updated": "2022-10-27",
"certification_date": "2022-10-27",
"status": "A",
"authorized_official_last_name": "POLLOCK",
"authorized_official_first_name": "CHRIS",
"authorized_official_title_or_position": "MD",
"authorized_official_telephone_number": "865-562-3232",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Surgery, Vascular Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lenoir City, TN
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- Heather McCoy Hutchings
- Jonathan Hutchings
- Independent Physical Therapy LLC
- Ingles Markets Inc
- Jennifer Marie Isaacs
- Ivan N Cooper, DPM, PC
- Jodi Lynn Jagodzinski
- Aliyah Jenkins
- Janice Teague Jenkins
All providers in Lenoir City, TN · Vascular Surgery Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.