Organization Active NPI

Eye Surgery Center of Knoxville, LLC

  • Ambulatory Surgical Clinic/Center
  • Powell, TN
National Provider Identifier
1255860383
Registry record updated Aug 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
EYE SURGERY CENTER OF KNOXVILLE, LLC
Practice address
7739 Dannaher Drive
Powell, TN 37849
Phone
(865) 339-4200
Fax
(865) 362-5532
NPI assigned
Jun 12, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2019

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

Authorized official

Name
Mr. Stephen H Rudolph Sr., CPA
Title
Chief Operating Officer
Phone
(865) 339-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

7739 Dannaher Drive
Powell, TN 37849

Mailing address

448 N Cedar Bluff Rd Ste 255
Knoxville, TN 37923-3612
Phone (865) 339-4200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180629002603 TN Part B Supplier - Ambulatory Surgical Center 4587910773 Practice locations: Powell, TN

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Eye Surgery Center of Knoxville LLCCCN 44C0001194
Medicare certification status
ActiveFrom the Provider of Services file

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
44D2141930Eye Surgery Center of Knoxville7739 Dannaher Way, Powell, TN 37849Certificate of waiverDec 27, 2027

National Provider Directory

National Provider Directory

Locations

448 N Cedar Bluff Rd
Knoxville, TN 37923

Practitioners & affiliated clinicians

Practitioners 1

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": "1497225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566345600000",
    "number": "1255860383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "448 N CEDAR BLUFF RD STE 255",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379233612",
            "telephone_number": "865-339-4200",
            "fax_number": "865-362-5532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7739 DANNAHER DRIVE",
            "city": "POWELL",
            "state": "TN",
            "postal_code": "37849",
            "telephone_number": "865-339-4200",
            "fax_number": "865-362-5532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SURGERY CENTER OF KNOXVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-12",
        "last_updated": "2019-08-21",
        "status": "A",
        "authorized_official_last_name": "RUDOLPH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "865-339-4200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Powell, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2019; 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.