NPIMap

Organization Active NPI

East Tennessee Cardiovascular Surgery Group, P.C

  • Contractor
  • Knoxville, TN
National Provider Identifier
1679525448
Registry record updated Oct 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ContractorTaxonomy code 171W00000X
Legal business name
EAST TENNESSEE CARDIOVASCULAR SURGERY GROUP, P.C
Practice address
9125 Cross Park Drive
Suite 200
Knoxville, TN 37923-4505
Phone
(865) 632-5900
Fax
(865) 637-2114
NPI assigned
May 17, 2006
Last updated
Oct 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2015

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

Authorized official

Name
Mr. Robert Craig Brent
Title
Cao
Phone
(865) 632-5900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ContractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 171W00000X TN Primary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208G00000X TN

Addresses

Primary practice location

9125 Cross Park Drive
Suite 200
Knoxville, TN 37923-4505

Mailing address

9125 Cross Park Drive
Suite 200
Knoxville, TN 37923-4505
Phone (865) 632-5900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081027000403 TN Part B Supplier - Clinic/Group Practice 6608934203 Receives reassigned benefits from 32 practitioners
Practice locations: Knoxville, TN; Oak Ridge, TN

National Provider Directory

National Provider Directory

Member of 1

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

Locations

101 E Blount Ave
Ste 800
Knoxville, TN 37920
Phone (865) 632-5900

1819 Clinch Ave
Ste 108
Knoxville, TN 37916
Phone (865) 541-4062

1915 White Ave
Knoxville, TN 37916
Phone (423) 977-1065

9125 Cross Park Dr
Ste 200
Knoxville, TN 37923
Phone (865) 632-5900

Dept 888101
Knoxville, TN 37995

Practitioners & affiliated clinicians

Practitioners 42

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 42

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444089600000",
    "number": "1679525448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9125 CROSS PARK DRIVE",
            "address_2": "SUITE 200",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234505",
            "telephone_number": "865-632-5900",
            "fax_number": "865-637-2114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9125 CROSS PARK DRIVE",
            "address_2": "SUITE 200",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234505",
            "telephone_number": "865-632-5900",
            "fax_number": "865-637-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE CARDIOVASCULAR SURGERY GROUP, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2015-10-06",
        "status": "A",
        "authorized_official_last_name": "BRENT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "CRAIG",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "865-632-5900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Contractor",
            "state": "TN",
            "license": null,
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "TN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; 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.