NPIMap

Organization Active NPI

Jay Michael Trussler DO PC

  • Primary Care Clinic/Center
  • Manchester, TN
National Provider Identifier
1164618229
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
JAY MICHAEL TRUSSLER DO PC
Practice address
585 Interstate Dr
Suite B
Manchester, TN 37355-3191
Phone
(931) 728-9000
Fax
(931) 728-2726
NPI assigned
Sep 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Authorized official

Name
Brooke Sain
Title
Practice Manager
Phone
(931) 728-9000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 1634 TN
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

585 Interstate Dr
Suite B
Manchester, TN 37355-3191

Mailing address

585 Interstate Dr
Suite B
Manchester, TN 37355-3191
Phone (931) 728-9000

Other practice location 1

847 W Main St
Monteagle, TN 37356-7028
Phone (931) 924-7000

Other identifiers 1

IdentifierTypeStateIssuer
3730274MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050706000958 TN Part B Supplier - Clinic/Group Practice 4880630375 Receives reassigned benefits from 9 practitioners
Practice locations: Manchester, TN; Monteagle, TN

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
44D1095622Jay Michael Trussler, DO PC585 Interstate Dr, Suite B, Manchester, TN 37355Certificate of waiverApr 12, 2027
44D2052184Jay Michael Trussler DO PC847 West Main Street, Monteagle, TN 37356Certificate of waiverJan 6, 2027

National Provider Directory

National Provider Directory

Locations

1321 McArthur St
Manchester, TN 37355
Phone (931) 728-0772

585 Interstate Dr
Ste B
Manchester, TN 37355
Phone (931) 728-0902

847 W Main St
Monteagle, TN 37356
Phone (931) 924-7000

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1164618229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "585 INTERSTATE DR",
            "address_2": "SUITE B",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373553191",
            "telephone_number": "931-728-9000",
            "fax_number": "931-728-2726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 INTERSTATE DR",
            "address_2": "SUITE B",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373553191",
            "telephone_number": "931-728-9000",
            "fax_number": "931-728-2726"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "847 W Main St",
            "address_purpose": "LOCATION",
            "city": "Monteagle",
            "state": "TN",
            "postal_code": "373567028",
            "country_code": "US",
            "telephone_number": "931-924-7000",
            "fax_number": "931-728-2726",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JAY MICHAEL TRUSSLER DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-21",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "SAIN",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "931-728-9000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "1634",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3730274",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.