Organization Active NPI

Middle Tennessee Urology Specialists PLLC

  • Urology Physician
  • Murfreesboro, TN
National Provider Identifier
1194944660
Registry record updated Feb 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
0544566 Issued in TN
Legal business name
MIDDLE TENNESSEE UROLOGY SPECIALISTS PLLC
Practice address
1747 Medical Center Pkwy
Suite 210
Murfreesboro, TN 37129-2563
Phone
(615) 893-1600
Fax
(615) 225-6887
NPI assigned
Apr 24, 2007
Last updated
Feb 22, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2012

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

Authorized official

Name
Mrs. Kim Bullock
Title
Financial Manager
Phone
69158931600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X 0544566 TN Primary

Addresses

Primary practice location

1747 Medical Center Pkwy
Suite 210
Murfreesboro, TN 37129-2563

Mailing address

Post Office Box 7125
Murfreesboro, TN 37133-7125
Phone (866) 220-7391

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070719000567 TN Part B Supplier - Clinic/Group Practice 3476654518 Receives reassigned benefits from 7 practitioners
Practice locations: Manchester, TN; Murfreesboro, TN; Smyrna, 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
44D1069363Middle Tennessee Urology Specialists1747 Medical Center Parkway Suite #210, Murfreesboro, TN 37129Certificate of waiverMay 31, 2028

National Provider Directory

National Provider Directory

Locations

1747 Medical Center Pkwy
Murfreesboro, TN 37129
Phone (615) 896-7477

1747 Medical Center Pkwy
Ste 2
Murfreesboro, TN 37129

Interoperability endpoints

  • Direct secure messaging: gregstewart@mtus.medalliesdirect.net
  • Direct secure messaging: lucillecox@mtus.medalliesdirect.net
  • Direct secure messaging: brennanhyler@mtus.medalliesdirect.net
  • Direct secure messaging: chadjackson@mtus.medalliesdirect.net
  • Direct secure messaging: robertdray@mtus.medalliesdirect.net
  • Direct secure messaging: robertbass@mtus.medalliesdirect.net
  • Direct secure messaging: jamespayne@mtus.medalliesdirect.net

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": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329868800000",
    "number": "1194944660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "POST OFFICE BOX 7125",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371337125",
            "telephone_number": "866-220-7391",
            "fax_number": "615-261-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1747 MEDICAL CENTER PKWY",
            "address_2": "SUITE 210",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371292563",
            "telephone_number": "615-893-1600",
            "fax_number": "615-225-6887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLE TENNESSEE UROLOGY SPECIALISTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2012-02-22",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "FINANCIAL MANAGER",
        "authorized_official_telephone_number": "69158931600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "TN",
            "license": "0544566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murfreesboro, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; 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.