Van Dyck ASC, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

TN23 Issued in TN

Legal business name

VAN DYCK ASC, LLC

Practice address

1024 Kelley Dr
Paris, TN 38242-4500

Phone

(731) 642-5003

Fax

(731) 642-8756

NPI assigned

Jul 7, 2006

Last updated

Feb 17, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James C Loden, M.D.NPI 1659330272

Title

Owner/Medical Director

Phone

(731) 642-5003

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Listed as

Van Dyck ASC LLCCCN 44C0001026

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicholas Hackett, MD

  • Ophthalmology Physician
  • Murfreesboro, TN
  • NPI 1649663311
  Medicare reassignment NPD
• James C Loden, M.D.

  • Ophthalmology Physician
  • Goodlettsville, TN
  • NPI 1659330272
  NPD (past) Authorized official

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1760414056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 KELLEY DR",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382424500",
            "telephone_number": "731-642-5003",
            "fax_number": "731-642-8756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 KELLEY DR",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382424500",
            "telephone_number": "731-642-5003",
            "fax_number": "731-642-8756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN DYCK ASC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "LODEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "731-642-5003",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TN",
            "license": "0000000023",
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TN",
            "license": "TN23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3288423",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danny Turner, DPH
• Vince Charles Tusa, M.D.
• Twin Lakes Dental Associates
• Belinda Sheryl Underwood, LCSW
• Brandy Urban
• Dennis Vance, CMSW
• Amy Vawter, LCSW
• Vcphcs XX, LLC
• Mac Casey Vernon, DPH
• Mary Kathy Verwey

• Ambulatory Surgical Clinic/Center in Paris, TN
• Providers in Paris, TN by specialty
• Ambulatory Surgical Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; 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.