Renaissance Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

RENAISSANCE SURGERY CENTER, LLC

Practice address

320 Bristol West Blvd Ste 1a
Bristol, TN 37620-8773

Phone

(423) 844-1399

NPI assigned

Jan 10, 2019

Organization subpart

No

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

Authorized official

Name

Randall Sermons

Title

Owner

Phone

(423) 857-2028

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Listed as

Renaissance Surgery Center LLCCCN 44C0001197

Medicare certification status

ActiveFrom the Provider of Services file

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

{
    "created_epoch": "1547078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1780157990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "address_2": "ATTN CREDENTIALING",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "37662",
            "telephone_number": "423-857-2066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 BRISTOL WEST BLVD STE 1A",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376208773",
            "telephone_number": "423-844-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-10",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "SERMONS",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-857-2028"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Barbara Raykowitz, LPC
• Ready Set Grow Pediatric Therapy LLC
• Scottie Reagan II, DDS
• Donald Smith Redford, D.D.S.
• Annette Sandra Reece, LBA, BCBA
• Michael Wayne Rentz, MD
• Inger L Reynolds, CRNA
• Robert David Reynolds Jr., APRN
• Robert Scott Reynolds, PT, ATC
• C'Je Slagle Rhea, PHARMD

• Ambulatory Surgical Clinic/Center in Bristol, TN
• Providers in Bristol, 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 Mar 16, 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.