NPIMap

Organization Active NPI

Cumberland Dermatology, P.C.

  • Specialist
  • Crossville, TN
National Provider Identifier
1346236361
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
37062 Issued in TN
Legal business name
CUMBERLAND DERMATOLOGY, P.C.
Practice address
29 Taylor Ave
Suite 101
Crossville, TN 38555-4526
Phone
(931) 484-6061
Fax
(931) 484-6062
NPI assigned
Sep 26, 2005
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Dr. Kendall Anne Morrison, MDNPI 1427044320
Title
Physician/Owner/President
Phone
(931) 484-6061

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
Specialist 174400000X 37062 TN Primary

Addresses

Primary practice location

29 Taylor Ave
Suite 101
Crossville, TN 38555-4526

Mailing address

29 Taylor Ave
Suite 101
Crossville, TN 38555-4526
Phone (931) 484-6061

Other practice location 1

303 N Oak Ave
Cookeville, TN 38501-2439
Phone (931) 484-6061

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041115001255 TN Part B Supplier - Clinic/Group Practice 1355305897 Receives reassigned benefits from 10 practitioners
Practice locations: Cookeville, TN; Crossville, TN

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
44D1013778Cumberland Dermatology, PC29 Taylor Ave, Suite 101, Crossville, TN 38555ComplianceMar 16, 2028

National Provider Directory

National Provider Directory

Locations

303 N Oak Ave
Cookeville, TN 38501
Phone (931) 484-6061

567 S Willow Ave
Cookeville, TN 38501
Phone (931) 250-1932

29 Taylor Ave
Ste 101
Crossville, TN 38555
Phone (931) 484-6061

29 Taylor Ave
Ste 210
Crossville, TN 38555
Phone (931) 707-5313

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1346236361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 TAYLOR AVE",
            "address_2": "SUITE 101",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554526",
            "telephone_number": "931-484-6061",
            "fax_number": "931-484-6062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 TAYLOR AVE",
            "address_2": "SUITE 101",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554526",
            "telephone_number": "931-484-6061",
            "fax_number": "931-484-6062"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 N Oak Ave",
            "address_purpose": "LOCATION",
            "city": "Cookeville",
            "state": "TN",
            "postal_code": "385012439",
            "country_code": "US",
            "telephone_number": "931-484-6061",
            "fax_number": "931-484-6062",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CUMBERLAND DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-26",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "MORRISON",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER/PRESIDENT",
        "authorized_official_telephone_number": "931-484-6061",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TN",
            "license": "37062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crossville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.