Advanced Diagnostic Imaging, PC
Organization Active NPI Orthopaedic Surgery Physician · Knoxville, TN
NPI 1487435467 · NPPES record last updated Oct 6, 2023
Key facts
- NPI
- 1487435467
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- ADVANCED DIAGNOSTIC IMAGING, PC
- Practice address
- 10810 Parkside Dr Ste 209
Knoxville, TN 37934-1985 - Phone
- (865) 251-3030
- Fax
- (865) 966-0191
- NPI assigned
- Oct 6, 2023
- Organization subpart
- No
Authorized official
- Name
- Susan Fenton
- Title
- Credentialing Director
- Phone
- (615) 239-2018
Corporate family (same tax ID) 24
Practitioners 1
-
Melissa G Reynolds, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250107000105 | TN | DME Supplier - Physician - Orthopedic/Orthopedic Surgery | 7315848140 | Practice locations: Knoxville, TN |
National Provider Directory
- Tax ID family
- Advancd Diagnostic Imaging PC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | Yes |
Addresses
Primary practice location
10810 Parkside Dr Ste 209
Knoxville, TN 37934-1985
Mailing address
3024 Business Park Cir
Goodlettsville, TN 37072-3132
Phone (612) 329-2018
Other names
- OrthoKnox
NPI Registry JSON
{
"created_epoch": "1696550400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1696550400000",
"number": "1487435467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3024 BUSINESS PARK CIR",
"city": "GOODLETTSVILLE",
"state": "TN",
"postal_code": "370723132",
"telephone_number": "612-329-2018",
"fax_number": "615-851-2018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10810 PARKSIDE DR STE 209",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379341985",
"telephone_number": "865-251-3030",
"fax_number": "865-966-0191"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADVANCED DIAGNOSTIC IMAGING, PC",
"organizational_subpart": "NO",
"enumeration_date": "2023-10-06",
"last_updated": "2023-10-06",
"certification_date": "2023-10-06",
"status": "A",
"authorized_official_last_name": "FENTON",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
"authorized_official_telephone_number": "615-239-2018"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "OrthoKnox",
"code": "3",
"type": "Doing Business As"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.