NPIMap

Organization Active NPI

Upper Cumberland Otolaryngology Clinic, PC

  • Specialist
  • Cookeville, TN
National Provider Identifier
1598821464
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC
Practice address
100 W 4TH St
Suite 200
Cookeville, TN 38501-2448
Phone
(931) 528-1575
Fax
(931) 526-2962
NPI assigned
Dec 28, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Cindy D Smith
Title
Business Manager
Phone
(931) 520-5832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

100 W 4TH St
Suite 200
Cookeville, TN 38501-2448

Mailing address

100 W 4TH St
Suite 200
Cookeville, TN 38501-2448
Phone (931) 528-1575

Other identifiers 2

IdentifierTypeStateIssuer
2005687OtherTNBCBS
3378945MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071018000126 TN Part B Supplier - Clinic/Group Practice 1850487158 Receives reassigned benefits from 9 practitioners
Practice locations: Cookeville, TN; McMinnville, TN; Crossville, TN

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CJCECD

Practitioners & affiliated clinicians

Practitioners 12

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": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598821464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W 4TH ST",
            "address_2": "SUITE 200",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012448",
            "telephone_number": "931-528-1575",
            "fax_number": "931-526-2962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W 4TH ST",
            "address_2": "SUITE 200",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012448",
            "telephone_number": "931-528-1575",
            "fax_number": "931-526-2962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "931-520-5832"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2005687",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3378945",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.