Jack Monroe Visca

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

7121 Issued in TN

Practice address

49 Cleveland St Ste 350
Crossville, TN 38555-2898

Phone

(931) 459-7720

NPI assigned

Apr 8, 2026

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cumberland Medical Center Hospital, Crossville, TN, CCN 440009

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: visca.jack.monroe@covenanthealth.cernerdirect.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.

• Covenant Medical Group, Inc.

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1457302010
  Medicare reassignment

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

• Cumberland Medical Center, Inc.

  • General Acute Care Hospital
  • Crossville, TN
  • NPI 1871596403
  Care Compare affiliation

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

{
    "created_epoch": "1775606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777852800000",
    "number": "1710829742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7331 CRESTHILL DR APT E5",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379195918",
            "telephone_number": "901-606-9357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 CLEVELAND ST STE 350",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385552898",
            "telephone_number": "931-459-7720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "421 S Main St",
            "address_purpose": "LOCATION",
            "city": "Crossville",
            "state": "TN",
            "postal_code": "385555031",
            "country_code": "US",
            "telephone_number": "931-484-9511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VISCA",
        "first_name": "JACK",
        "middle_name": "MONROE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-04-08",
        "last_updated": "2026-05-04",
        "certification_date": "2026-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "7121",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "7121",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q112201",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "visca.jack.monroe@covenanthealth.cernerdirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "49 Cleveland St Ste 350",
            "city": "Crossville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "385552898",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ryan Wagner Varnum
• Vascular Wellness Center Inc
• Victor a. Shada, D.O., P.C.
• Vianney Epina Villaruz, MD
• Adrian Vinas
• Kimberly Dawn Wagner, FNP-BC
• Cindy Wakham, D.PH.
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co

• Surgical Physician Assistant in Crossville, TN
• Providers in Crossville, TN by specialty
• Surgical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.