NPIMap

Organization Active NPI

Cookeville Regional Medical Group, Inc

  • Multi-Specialty Clinic/Center
  • Cookeville, TN
National Provider Identifier
1649202102
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
COOKEVILLE REGIONAL MEDICAL GROUP, INC
Practice address
140 W 7TH St
Cookeville, TN 38501-1726
Phone
(931) 783-5582
NPI assigned
Jul 7, 2006
Last updated
Jun 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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

Authorized official

Name
Marilyn C Key
Title
Ceo
Phone
(931) 783-2481

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X TN Primary
Surgical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AS0400X TN
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X TN

Addresses

Primary practice location

140 W 7TH St
Cookeville, TN 38501-1726

Mailing address

PO Box 15060
Belfast, ME 04915-4045
Phone (931) 783-5857

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050309000874 TN Part B Supplier - Clinic/Group Practice 8325092638 Receives reassigned benefits from 132 practitioners
Practice locations: Cookeville, TN; Crossville, TN

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1 Medical Center Blvd
Ste 102
Cookeville, TN 38501

1 Medical Center Blvd
Ste 103
Cookeville, TN 38501
Phone (931) 783-2770

1 Medical Center Blvd
Ste 201
Cookeville, TN 38501

100 W 3rd St
Ste B
Cookeville, TN 38501
Phone (931) 528-6852

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

120 Walnut Commons Ln
Cookeville, TN 38501
Phone (931) 526-7699

120 Walnut Commons Ln
Ste B
Cookeville, TN 38501
Phone (931) 528-2557

127 N Oak Ave
Cookeville, TN 38501

127 N Oak Ave
#A
Cookeville, TN 38501
Phone (931) 783-2361

215 W 6th St
Ste A
Cookeville, TN 38501
Phone (931) 520-4885

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

406 N Whitney Ave
Ste 5
Cookeville, TN 38501
Phone (931) 783-2904

438 N Whitney Ave
Cookeville, TN 38501
Phone (931) 783-2616

438 N Whitney Ave
Ste 1
Cookeville, TN 38501
Phone (931) 526-3432

4929 Peavine Rd
Ste 107
Crossville, TN 38571
Phone (931) 484-3050

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10383/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 237

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.

View all 237

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1649202102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15060",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154045",
            "telephone_number": "931-783-5857",
            "fax_number": "931-526-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 W 7TH ST",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385011726",
            "telephone_number": "931-783-5582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOKEVILLE REGIONAL MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A",
        "authorized_official_last_name": "KEY",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "931-783-2481"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "TN",
            "license": null,
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Jun 21, 2023; 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.