Paul Daniel Ptak, SA-C, RSA

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

Practice address

5300 Cherry Creek Rd
Cookeville, TN 38506-7007

Phone

(847) 494-1940

NPI assigned

Dec 17, 2013

Last updated

Oct 22, 2021By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Tristar Surgical Services, LLC

  • Surgical Assistant
  • Cookeville, TN
  • NPI 1053708909
  NPD Authorized official

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

{
    "created_epoch": "1387238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634860800000",
    "number": "1730500760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 CHERRY CREEK RD",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385067007",
            "telephone_number": "847-494-1940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 CHERRY CREEK RD",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385067007",
            "telephone_number": "847-494-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PTAK",
        "first_name": "PAUL",
        "middle_name": "DANIEL",
        "name_prefix": "Mr.",
        "credential": "SA-C, RSA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-12-17",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Providence Health Solutions LLC
• Madelaine Pruitt, CRNA
• Steven Kyle Pruitt
• Jazmine Casal Pszenitzki, MD
• Melissa M Ptak, MSN, FNP-C, CDCES
• Publix Tennessee, LLC (Publix Pharmacy #1634)
• Crystal Marie Pugh, LMT
• Kathryn Pugh
• Putnam County Board of Education
• Putnam County Health Dept

• Surgical Assistant in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Surgical Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.