NPIMap

Organization Active NPI

Pma Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Johnson City, TN
National Provider Identifier
1720024284
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
PMA SURGERY CENTER, LLC
Practice address
101 Med Tech Pkwy
Suite 205
Johnson City, TN 37604-4007
Phone
(423) 232-6120
NPI assigned
Jun 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Tracy Bays
Title
Office Manager
Phone
(423) 232-6120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X TN Primary

Addresses

Primary practice location

101 Med Tech Pkwy
Suite 205
Johnson City, TN 37604-4007

Mailing address

101 Med Tech Pkwy
Suite 205
Johnson City, TN 37604-4007
Phone (423) 232-6120

Other identifiers 5

IdentifierTypeStateIssuer
TN010OtherTNJOHN DEERE
0007949702OtherTNAETNA
3288982MedicaidTN
4097786OtherTNBC/BS
P00188946OtherTNMEDICARE RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050203000978 TN Part B Supplier - Ambulatory Surgical Center 3779534029 1 other NPI on this enrollment
Practice locations: Johnson City, TN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Pma Surgery Center LLCCCN 44C0001144
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Pma Surgery Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720024284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MED TECH PKWY",
            "address_2": "SUITE 205",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044007",
            "telephone_number": "423-232-6120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MED TECH PKWY",
            "address_2": "SUITE 205",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044007",
            "telephone_number": "423-232-6120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMA SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAYS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "423-232-6120"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "TN010",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0007949702",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3288982",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "4097786",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00188946",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.