NPIMap

Organization Active NPI

Upper Cumberland Orthopedic Surgery, PC

  • Multi-Specialty Clinic/Center
  • Cookeville, TN
National Provider Identifier
1184610859
Registry record updated Jan 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
UPPER CUMBERLAND ORTHOPEDIC SURGERY, PC
Practice address
105 S. Willow Ave.
Cookeville, TN 38501
Phone
(931) 526-9518
Fax
(931) 372-0087
NPI assigned
Sep 27, 2005
Last updated
Jan 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2020

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

Authorized official

Name
Paula A Easterly
Title
Manager
Phone
(931) 372-7716

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Neuromusculoskeletal Medicine) Physician 204C00000X
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

105 S. Willow Ave.
Cookeville, TN 38501

Mailing address

105 S. Willow Ave
Cookeville, TN 38501
Phone (931) 526-9518

Other identifiers 2

IdentifierTypeStateIssuer
65942575MedicaidKY
3704956MedicaidTN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jjestus@t1ortho.gwaydirect.com

National Provider Directory

National Provider Directory

Locations

105 S Willow Ave
#317
Cookeville, TN 38501

105 S Willow Ave
Ste 100
Cookeville, TN 38501
Phone (931) 267-4929

404 N Hickory Ave
Cookeville, TN 38501

Interoperability endpoints

  • Direct secure messaging: jjestus@t1ortho.gwaydirect.com

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577923200000",
    "number": "1184610859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S. WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "38501",
            "telephone_number": "931-526-9518",
            "fax_number": "931-372-0087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S. WILLOW AVE.",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "38501",
            "telephone_number": "931-526-9518",
            "fax_number": "931-372-0087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER CUMBERLAND ORTHOPEDIC SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A",
        "authorized_official_last_name": "EASTERLY",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "931-372-7716"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65942575",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3704956",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jjestus@t1ortho.gwaydirect.com",
            "affiliation": "N",
            "address_1": "105 S. Willow Ave.",
            "city": "Cookeville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "38501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; 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.