NPIMap

Individual provider Active NPI

Roy R Anderson, M.D.

  • Internal Medicine Physician
  • Cookeville, TN
National Provider Identifier
1386668838
Registry record updated May 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
7610 Issued in TN
Practice address
340 N Cedar Ave
Cookeville, TN 38501-2421
Phone
(931) 783-5353
Fax
(931) 783-4994
NPI assigned
Jul 27, 2006
Last updated
May 27, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 7610 TN Primary

Addresses

Primary practice location

340 N Cedar Ave
Cookeville, TN 38501-2421

Mailing address

140 W 7TH St
Cookeville, TN 38501-1726
Phone (931) 783-5582

Other identifiers 3

IdentifierTypeStateIssuer
5590139OtherTNBCBS
Q023465MedicaidTN
7100431530MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050330000358 TN Practitioner - Internal Medicine 9830145317 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Tennessee, HSC, College of Medicine, 1971
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cookeville Regional Medical Group IncGroup PAC ID 8325092638, 54 clinicians

Practice addresses (Care Compare)

100 W 4TH St
Suite 350
Cookeville, TN 38501-4225
Phone (931) 783-2753

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
40.99 of 100Reported as group
Quality
58.34
Promoting interoperability
0
Improvement activities
0
Cost
78.29

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Cookeville Regional Medical Group, Inc CurrentSince Sep 1, 2016 Accepting new patients

Locations

100 W 4th St
Ste 350
Cookeville, TN 38501
Phone (931) 646-2901

127 N Oak Ave
#D
Cookeville, TN 38501

140 W 7th St
Cookeville, TN 38501
Phone (931) 783-5582

201 W 5th St
Cookeville, TN 38501
Phone (615) 322-7454

228 W 4th St
Ste 301
Cookeville, TN 38501
Phone (931) 526-4349

340 N Cedar Ave
Cookeville, TN 38501
Phone (931) 528-6496

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10383/brand/1/csg/1/fhir/r4
  • Direct secure messaging: roy.anderson.1@10383.direct.athenahealth.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653609600000",
    "number": "1386668838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 W 7TH ST",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385011726",
            "telephone_number": "931-783-5582",
            "fax_number": "931-526-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 N CEDAR AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012421",
            "telephone_number": "931-783-5353",
            "fax_number": "931-783-4994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "ROY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "7610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5590139",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q023465",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100431530",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.