NPIMap

Organization Active NPI

Surgical Alliance of Middle Tennessee, PLC

  • Surgery Physician
  • Springfield, TN
National Provider Identifier
1255387569
Registry record updated Sep 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SURGICAL ALLIANCE OF MIDDLE TENNESSEE, PLC
Practice address
417 Northcrest Dr
Springfield, TN 37172-3963
Phone
(615) 384-8211
Fax
(615) 384-5859
NPI assigned
May 26, 2006
Last updated
Sep 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2019

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

Authorized official

Name
Dr. Keith Goldberg, M.D.NPI 1528009149
Title
President
Phone
(615) 384-8211

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Surgery Physician 208600000X Primary

Addresses

Primary practice location

417 Northcrest Dr
Springfield, TN 37172-3963

Mailing address

417 Northcrest Dr
Springfield, TN 37172-3963
Phone (615) 384-8211

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060725000120 TN Part B Supplier - Clinic/Group Practice 4284647967 Receives reassigned benefits from 12 practitioners
Practice locations: Clarksville, TN; Dickson, TN; Hendersonville, TN; Springfield, TN

National Provider Directory

National Provider Directory

Locations

127 Crestview Park Dr
Ste 105
Dickson, TN 37055
Phone (615) 384-8211

320 Northcrest Dr
#320
Springfield, TN 37172

Practitioners & affiliated clinicians

Practitioners 12

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": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568160000000",
    "number": "1255387569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 NORTHCREST DR",
            "city": "SPRINGFIELD",
            "state": "TN",
            "postal_code": "371723963",
            "telephone_number": "615-384-8211",
            "fax_number": "615-384-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 NORTHCREST DR",
            "city": "SPRINGFIELD",
            "state": "TN",
            "postal_code": "371723963",
            "telephone_number": "615-384-8211",
            "fax_number": "615-384-5859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL ALLIANCE OF MIDDLE TENNESSEE, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2019-09-11",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-384-8211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.