Active NPI
Eye Surgery Center of Knoxville, LLC
- Ambulatory Surgical Clinic/Center
- Powell, TN
National Provider Identifier
1255860383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Surgical Clinic/Center
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 LLC
- Medicare certification status
- Active
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2141930 | Eye Surgery Center of Knoxville | Certificate of waiver | Dec 27, 2027 |
National Provider Directory
National Provider DirectoryLocations
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.
-
- Ophthalmology Physician
- Knoxville, TN
- NPI 1619985066
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.