NPIMap

Organization Active NPI

Kofi Nuako, MD, PC

Doing business as Advanced Gastro

  • Gastroenterology Physician
  • Union City, TN
National Provider Identifier
1245276765
Registry record updated Mar 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD31272 Issued in TN
Legal business name
KOFI NUAKO, MD, PC
Doing business as
Advanced Gastro
Practice address
1109 E Reelfoot Ave
Suite C
Union City, TN 38261-5856
Phone
(731) 884-0600
Fax
(731) 885-6171
NPI assigned
Jun 22, 2006
Last updated
Mar 13, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2018

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

Authorized official

Name
Hayley Maree Summers, CPPM
Title
Practice Manager
Phone
(731) 884-0600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD31272 TN Primary

Addresses

Primary practice location

1109 E Reelfoot Ave
Suite C
Union City, TN 38261-5856

Mailing address

1109 E Reelfoot Ave
Suite C
Union City, TN 38261-5856
Phone (731) 884-0600

Other names 1

  • Advanced Gastro Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205000058 TN Part B Supplier - Clinic/Group Practice 0446143374 Receives reassigned benefits from 6 practitioners
Practice locations: Union City, 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
44D1022786Kofi Nuako MD PC1109 E Reelfoot Avenue, Suite B, Union City, TN 38261ComplianceFeb 15, 2028

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1109 E Reelfoot Ave
Ste C
Union City, TN 38261
Phone (731) 884-0600

Practitioners & affiliated clinicians

Practitioners 6

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": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520899200000",
    "number": "1245276765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 E REELFOOT AVE",
            "address_2": "SUITE C",
            "city": "UNION CITY",
            "state": "TN",
            "postal_code": "382615856",
            "telephone_number": "731-884-0600",
            "fax_number": "731-885-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 E REELFOOT AVE",
            "address_2": "SUITE C",
            "city": "UNION CITY",
            "state": "TN",
            "postal_code": "382615856",
            "telephone_number": "731-884-0600",
            "fax_number": "731-885-6171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOFI NUAKO, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2018-03-13",
        "status": "A",
        "authorized_official_last_name": "SUMMERS",
        "authorized_official_first_name": "HAYLEY",
        "authorized_official_middle_name": "MAREE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "731-884-0600",
        "authorized_official_credential": "CPPM"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TN",
            "license": "MD31272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Gastro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Union City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2018; 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.