Timothy E Vivian, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

P0770 Issued in TN

Practice address

675 South Jefferson Ave
Cookeville, TN 38501-0949

Phone

(931) 520-0148

Fax

(931) 520-0152

NPI assigned

Sep 13, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: timothy.vivian.1@1385.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vivian Family Medical LLC

  dba Cookeville Family Medicine & Urgent Care

  • Medical Physician Assistant
  • Cookeville, TN
  • NPI 1568457851
  Medicare reassignment
• Cookeville Urgent Care

  • Urgent Care Clinic/Center
  • Cookeville, TN
  • NPI 1588769731
  NPD (past)

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340150400000",
    "number": "1679568968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 SOUTH JEFFERSON AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385010949",
            "telephone_number": "931-520-0148",
            "fax_number": "931-520-0152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 SOUTH JEFFERSON AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385010949",
            "telephone_number": "931-520-0148",
            "fax_number": "931-520-0152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIVIAN",
        "first_name": "TIMOTHY",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2012-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "P0770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Elizabeth Vickers
• James I Vinson, DDS
• Melissa Carol Vinson, RN
• Catherine Virden
• Vivian Family Medical LLC (Cookeville Family Medicine & Urgent Care)
• Danielle Rose Vogel, LPC-MHSP
• Volunteer Medical Group, P.C.
• Rhiannon Michelle Voss
• Louis Frederick Vossel Jr., M.D.
• Brian S Waggoner, MD

• Medical Physician Assistant in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Medical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.