Cookeville Regional Medical Group, Inc

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

Organization subpart

No

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

Addresses

Other identifiers 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maan Akram Anbari, M.D.

  • Gastroenterology Physician
  • Cookeville, TN
  • NPI 1952303166

  TN

  Medicare reassignment Care Compare group NPD
• Kayla Elizabeth Anderson, N.P.

  • Family Nurse Practitioner
  • Cookeville, TN
  • NPI 1699167791

  TN

  Medicare reassignment Care Compare group NPD
• Roy R Anderson, M.D.

  • Internal Medicine Physician
  • Cookeville, TN
  • NPI 1386668838

  TN

  Medicare reassignment Care Compare group NPD
• Phillip D Bertram, MD

  • Gastroenterology Physician
  • Cookeville, TN
  • NPI 1487648507

  TN

  Medicare reassignment Care Compare group NPD
• James Wade Bolton, DC, APRN, FNP-C

  • Family Nurse Practitioner
  • Cookeville, TN
  • NPI 1477559649

  TN

  Medicare reassignment Care Compare group NPD
• Maggie Bullock, NP-C

  • Family Nurse Practitioner
  • Cookeville, TN
  • NPI 1659751865

  TN

  Medicare reassignment Care Compare group NPD
• Anna Nicole D Christian, NP

  • Family Nurse Practitioner
  • Cookeville, TN
  • NPI 1992433270

  Nurse Practitioner, TN

  Medicare reassignment Care Compare group NPD
• Wendy S Dewberry, APRN

  • Acute Care Nurse Practitioner
  • Knoxville, TN
  • NPI 1063644243

  TN

  Medicare reassignment Care Compare group NPD
• Jason Donald Easterday, MD

  • Urology Physician
  • Cookeville, TN
  • NPI 1831689546

  TN

  Medicare reassignment Care Compare group NPD
• James Chike Ezi-Ashi, MD

  • Gastroenterology Physician
  • Cookeville, TN
  • NPI 1063473569

  TN

  Medicare reassignment Care Compare group NPD
• Justina S Fabich, NP

  • Nurse Practitioner
  • Cookeville, TN
  • NPI 1801513049
  Medicare reassignment Care Compare group NPD
• Timothy Scott Fournet, M.D.

  • Cardiovascular Disease Physician
  • Cookeville, TN
  • NPI 1780791764

  TN

  Medicare reassignment Care Compare group NPD

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Member of 1

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

• Cookeville Regional Medical Center

  • Hospitalist Physician
  • Cookeville, TN
  • NPI 1023397031

  Member Of

  NPD member

Locations

Interoperability endpoints

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

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "3727506",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cookeville Regional Medical Center
• Cookeville Regional Medical Center
• Cookeville Regional Medical Center
• Cookeville Regional Medical Center
• Cookeville Regional Medical Center
• Cookeville RX Inc.
• Cookeville RX Inc.
• Cookeville Senior Living LLC
• Cookeville SNF Healthcare LLC
• Cookeville Urgent Care

• All providers in Cookeville, TN
• Multi-Specialty Clinic/Center in Tennessee

• 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.