NPIMap

Organization Active NPI

Staton Southern Medical, PLLC

  • Family Medicine Physician
  • Carthage, TN
National Provider Identifier
1295033595
Registry record updated Mar 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
STATON SOUTHERN MEDICAL, PLLC
Practice address
131 Hospital Drive
Suite 2000
Carthage, TN 37030
Phone
(423) 364-4817
NPI assigned
Mar 10, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2011

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

Authorized official

Name
Brent D Staton, MDNPI 1508989450
Title
Physician
Phone
(423) 619-6282

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

131 Hospital Drive
Suite 2000
Carthage, TN 37030

Mailing address

131 Hospital Drive
Suite 2000
Carthage, TN 37030

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110421000422 TN Part B Supplier - Clinic/Group Practice 9335324193 Receives reassigned benefits from 1 practitioner
Practice locations: Cookeville, TN

National Provider Directory

National Provider Directory

Locations

1135 S Walnut Ave
Cookeville, TN 38501
Phone (615) 735-8008

507 Gordonsville Hwy
Ste 203
Gordonsville, TN 38563
Phone (615) 735-8008

Practitioners & affiliated clinicians

Practitioners 5

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": "1299715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299715200000",
    "number": "1295033595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 HOSPITAL DRIVE",
            "address_2": "SUITE 2000",
            "city": "CARTHAGE",
            "state": "TN",
            "postal_code": "37030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 HOSPITAL DRIVE",
            "address_2": "SUITE 2000",
            "city": "CARTHAGE",
            "state": "TN",
            "postal_code": "37030",
            "telephone_number": "423-364-4817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATON SOUTHERN MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-10",
        "last_updated": "2011-03-10",
        "status": "A",
        "authorized_official_last_name": "STATON",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "423-619-6282",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carthage, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2011; 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.