NPIMap

Organization Active NPI

Cumberland Pathology Associates PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Clarksville, TN
National Provider Identifier
1568434256
Registry record updated Feb 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
970 Issued in TN
Legal business name
CUMBERLAND PATHOLOGY ASSOCIATES PLLC
Practice address
1771 Madison St
Clarksville, TN 37043-4990
Phone
(931) 551-1939
Fax
(931) 221-2236
NPI assigned
Feb 6, 2006
Last updated
Feb 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2008

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

Authorized official

Name
Dr. Randall Robert Haase, D.O.NPI 1720050594
Title
President
Phone
(931) 551-1939

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
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X 970 TN Primary

Addresses

Primary practice location

1771 Madison St
Clarksville, TN 37043-4990

Mailing address

PO Box 30309
Charleston, SC 29417-0309
Phone (843) 554-9300

Other identifiers 1

IdentifierTypeStateIssuer
3708071MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070611000213 TN Part B Supplier - Clinic/Group Practice 6305944687 Receives reassigned benefits from 4 practitioners
Practice locations: Clarksville, TN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204243200000",
    "number": "1568434256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30309",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294170309",
            "telephone_number": "843-554-9300",
            "fax_number": "843-566-8780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1771 MADISON ST",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370434990",
            "telephone_number": "931-551-1939",
            "fax_number": "931-221-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND PATHOLOGY ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-06",
        "last_updated": "2008-02-29",
        "status": "A",
        "authorized_official_last_name": "HAASE",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "931-551-1939",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TN",
            "license": "970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3708071",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.