Fort Sanders West Op Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0000000025 Issued in TN

Legal business name

FORT SANDERS WEST OP SURGERY CENTER

Practice address

210 Fort Sanders West Blvd
Knoxville, TN 37922-3355

Phone

(865) 531-5200

Fax

(865) 531-5370

NPI assigned

Aug 1, 2006

Last updated

May 14, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Emily Hinojosa Simpson

Title

Credentialing Manager

Phone

(720) 630-0424

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Listed as

Urologic Surgery Center of KnoxvilleCCN 44C0001027

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Oak Ridge Urology Associates

  • Clinic Pharmacy
  • Oak Ridge, TN
  • NPI 1720118086

  Member Of

  NPD member

Locations

Practitioners 2

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.

• Mark A. Moser, CRNA

  • Certified Registered Nurse Anesthetist
  • Knoxville, TN
  • NPI 1871506006
  NPD (past)
• John David Owen, MD

  • Obstetrics & Gynecology Physician
  • Knoxville, TN
  • NPI 1205880028
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1326054172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 FORT SANDERS WEST BLVD",
            "address_2": "STE 200",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379223398",
            "telephone_number": "865-531-5200",
            "fax_number": "865-531-5370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 FORT SANDERS WEST BLVD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379223355",
            "telephone_number": "865-531-5200",
            "fax_number": "865-531-5370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT SANDERS WEST OP SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2024-05-14",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "SIMPSON",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "HINOJOSA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "720-630-0424"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TN",
            "license": "0000000025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR",
            "identifier": "165264500",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARITEN",
            "identifier": "702002007",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1000905",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3287277",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP TNCARE",
            "identifier": "100020229",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fort Sanders Regional Medical Center
• Fort Sanders Regional Medical Center (Fort Sanders Regional Infusion Services)
• Fort Sanders Regional Medical Center
• Fort Sanders Regional Medical Center
• Fort Sanders Regional Medical Center
• Alexandra Fort, FNP-BC
• Amber Fortenberry, LCSW
• William David Forth, DC
• Dawn M Fortich, LCSW
• Jairo Alfredo Fortich, M.D.

• Ambulatory Surgical Clinic/Center in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Ambulatory Surgical Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; 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.