Tennessee Pain Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

154 Issued in TN

Legal business name

TENNESSEE PAIN SURGERY CENTER, LLC

Practice address

5811 Crossings Blvd
Antioch, TN 37013-3130

Phone

(615) 941-4820

Fax

(615) 941-4989

NPI assigned

Jul 5, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Derek Oliver

Title

Business Office Manager

Phone

(615) 941-8501

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Listed as

Tennessee Pain Surgery Center LLCCCN 44C0001130

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

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322524800000",
    "number": "1518998764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5811 CROSSINGS BLVD",
            "city": "ANTIOCH",
            "state": "TN",
            "postal_code": "370133130",
            "telephone_number": "615-941-4820",
            "fax_number": "615-941-4989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5811 CROSSINGS BLVD",
            "city": "ANTIOCH",
            "state": "TN",
            "postal_code": "370133130",
            "telephone_number": "615-941-4820",
            "fax_number": "615-941-4989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENNESSEE PAIN SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2011-11-29",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "615-941-8501",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TN",
            "license": "154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Antioch, TN
• Providers in Antioch, 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 Nov 29, 2011; 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.