NPIMap

Individual provider Active NPI

Pushpendra K Jain, MD

  • Family Medicine Physician
  • Cookeville, TN
National Provider Identifier
1689748634
Registry record updated Nov 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD16449 Issued in TN
Practice address
225 N Willow Ave Ste 3
Cookeville, TN 38501-2335
Phone
(931) 528-8899
Fax
(931) 520-7655
NPI assigned
Nov 20, 2006
Last updated
Nov 9, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD16449 TN Primary

Addresses

Primary practice location

225 N Willow Ave Ste 3
Cookeville, TN 38501-2335

Mailing address

225 N Willow Ave
Cookeville, TN 38501-2335
Phone (931) 528-8899

Other practice location 1

229 Interstate Dr Ste 105
Crossville, TN 38555-2704
Phone (931) 250-5230

Other practice location 2

402 E Gore Ave
Gainesboro, TN 38562-9367
Phone (931) 268-6899

Other practice location 3

207 E Bockman Way
Sparta, TN 38583-2041
Phone (931) 836-6461

Other identifiers 2

IdentifierTypeStateIssuer
3018160MedicaidTN
3863723MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080826000783 TN Practitioner - General PracticePractitioner - Internal Medicine 4587569520 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General PracticeAlso: Internal Medicine
Education
Other, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cookeville Medical Center PCGroup PAC ID 0143125237, 9 clinicians

Practice addresses (Care Compare)

225 N Willow Ave
Cookeville, TN 38501-2451
Phone (931) 528-8899

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
16449TNMDMidwife
MD16449TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cookeville Medical Center PC Family Medicine CurrentSince Nov 15, 1996 Accepting new patients
Cookeville Regional Medical Center Past Accepting new patients
Upper Cumberland Medical Associates, PLLC PastSince May 22, 2007 Accepting new patients
Upper Cumberland Rural Health Clinic PLLC Past Accepting new patients
Upper Cumberland Rural Health Clinic PLLC Past Accepting new patients
Upper Cumberland Rural Health Clinic PLLC PastSince Jul 31, 2020 Accepting new patients
Upper Cumberland Rural Health Clinic PLLC Past Accepting new patients
Upper Cumberland Rural Health Clinic PLLC Past Accepting new patients
Upper Cumberland Rural Health Clinic PLLC Family Medicine Past Accepting new patients

Locations

225 N Willow Ave
Cookeville, TN 38501
Phone (931) 525-5454

225 N Willow Ave
Ste 1
Cookeville, TN 38501
Phone (931) 372-8700

225 N Willow Ave
Ste 2
Cookeville, TN 38501

225 N Willow Ave
Ste 3
Cookeville, TN 38501
Phone (931) 528-8899

225 N Willow Ave
Ste C
Cookeville, TN 38501
Phone (931) 525-5454

229 Interstate Dr
Crossville, TN 38555
Phone (931) 250-2530

229 Interstate Dr
Ste 105
Crossville, TN 38555
Phone (931) 250-5230

820 N Main St
Crossville, TN 38555
Phone (931) 250-5230

402 E Gore Ave
Gainesboro, TN 38562
Phone (931) 268-0221

207 E Bockman Way
Sparta, TN 38583
Phone (931) 528-5547

Interoperability endpoints

  • Direct secure messaging: crmchhsecure@crmchealth.brightreedirect.net
  • Direct secure messaging: pushpendra.jain.1@18192.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Upper Cumberland Rural Health Clinic PLLCCookeville, TN, CCN 443916 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%)
Corporate Director		 Apr 28, 2023
Nov 28, 1995
Cookeville Medical Clinic Gainesboro RHCGainesboro, TN, CCN 448904 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%)
Corporate Officer
Corporate Director		 Apr 28, 2023
Jul 15, 2010
Jul 15, 2010
Crossville Medical Clinic RHCCrossville, TN, CCN 883837 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%)
Corporate Officer (100%)
Operational/Managerial Control (100%)		 Apr 28, 2023
Jul 31, 2020
Jul 31, 2020
Sparta Medical Clinic RHCSparta, TN, CCN 883921 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%)
Corporate Officer (100%)
W-2 Managing Employee (100%)
Operational/Managerial Control (100%)		 Apr 28, 2023
Jul 31, 2020
Jul 31, 2020
Jul 31, 2020
Baxter Medical Clinic RHCBaxter, TN, CCN 888902 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Corporate Officer (100%)
W-2 Managing Employee (100%)
Operational/Managerial Control (100%)		 Jul 1, 2023
Jul 1, 2023
Jul 1, 2023
Jul 1, 2023
Rickman Medical Clinic RHCCookeville, TN, CCN 888924 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Corporate Officer (100%)
W-2 Managing Employee (100%)
Operational/Managerial Control (100%)		 Jul 1, 2023
Jul 1, 2023
Jul 1, 2023
Jul 1, 2023
Byrdstown Medical ClinicByrdstown, TN, CCN 888931 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Corporate Officer (100%)
W-2 Managing Employee (100%)
Operational/Managerial Control (100%)		 Jul 1, 2023
Jul 1, 2023
Jul 1, 2023
Jul 1, 2023
TN Pediatric & Adolescent CenterSparta, TN, CCN 888941 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Corporate Officer (100%)
W-2 Managing Employee (100%)
Operational/Managerial Control (100%)		 Mar 1, 2025
Mar 1, 2025
Mar 1, 2025
Mar 1, 2025
TN Pediatric & Adolescent CenterCookeville, TN, CCN 888937 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Corporate Officer (100%)
W-2 Managing Employee (100%)
Operational/Managerial Control (100%)		 Mar 1, 2025
Mar 1, 2025
Mar 1, 2025
Mar 1, 2025

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 10

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

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1689748634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 N WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012335",
            "telephone_number": "931-528-8899",
            "fax_number": "931-520-7655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N WILLOW AVE STE 3",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012335",
            "telephone_number": "931-528-8899",
            "fax_number": "931-520-7655"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "229 Interstate Dr Ste 105",
            "address_purpose": "LOCATION",
            "city": "Crossville",
            "state": "TN",
            "postal_code": "385552704",
            "country_code": "US",
            "telephone_number": "931-250-5230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "402 E Gore Ave",
            "address_purpose": "LOCATION",
            "city": "Gainesboro",
            "state": "TN",
            "postal_code": "385629367",
            "country_code": "US",
            "telephone_number": "931-268-6899",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "207 E Bockman Way",
            "address_purpose": "LOCATION",
            "city": "Sparta",
            "state": "TN",
            "postal_code": "385832041",
            "country_code": "US",
            "telephone_number": "931-836-6461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAIN",
        "first_name": "PUSHPENDRA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD16449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3018160",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3863723",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.