Octave TN Medical PLLC

Primary specialty

Neuroradiology PhysicianTaxonomy code 2085N0700X

Legal business name

OCTAVE TN MEDICAL PLLC

Practice address

912 Stuart LN
Brentwood, TN 37027-5822

Phone

(650) 459-0942

NPI assigned

Oct 19, 2022

Organization subpart

No

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

Authorized official

Name

Michael Edgeworth, MDNPI 1063637791

Title

Sole Member

Phone

(615) 406-4994

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael L Edgeworth, MD

  • Neurology Physician
  • Brentwood, TN
  • NPI 1063637791
  NPD Authorized official

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

{
    "created_epoch": "1666137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721260800000",
    "number": "1326764556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 STUART LN",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275822",
            "telephone_number": "615-406-4994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 STUART LN",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275822",
            "telephone_number": "650-459-0942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCTAVE TN MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-19",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A",
        "authorized_official_last_name": "EDGEWORTH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "615-406-4994",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Neuroradiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neuroradiology Physician in Brentwood, TN
• Providers in Brentwood, TN by specialty
• Neuroradiology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.