Individual provider Active NPI

Benjamin Ryan Summerlin, DC

  • Chiropractor
  • Crossville, TN
National Provider Identifier
1790429314
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3570 Issued in TN
Practice address
1364 Interstate Dr Ste 101
Crossville, TN 38555-6187
Phone
(931) 456-8880
Fax
(931) 456-8883
NPI assigned
Apr 21, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3570 TN Primary

Addresses

Primary practice location

1364 Interstate Dr Ste 101
Crossville, TN 38555-6187

Mailing address

1364 Interstate Dr Ste 101
Crossville, TN 38555-6187
Phone (931) 456-8880

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220503000712 TN Practitioner - Chiropractic 5698162006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Crawford ChiropracticGroup PAC ID 3375712193, 9 clinicians

Practice addresses (Care Compare)

1364 Interstate Dr
Suite 101
Crossville, TN 38555-6187
Phone (931) 456-8880

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Well Health Chiropractic Collierville PLLC Chiropractor CurrentSince Nov 3, 2024 Accepting new patients

Locations

875 W Poplar Ave
Ste 5
Collierville, TN 38017
Phone (615) 389-4303

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1650499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730937600000",
    "number": "1790429314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1364 INTERSTATE DR STE 101",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385556187",
            "telephone_number": "931-456-8880",
            "fax_number": "931-456-8883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1364 INTERSTATE DR STE 101",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385556187",
            "telephone_number": "931-456-8880",
            "fax_number": "931-456-8883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERLIN",
        "first_name": "BENJAMIN",
        "middle_name": "RYAN",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-21",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TN",
            "license": "3570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crossville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; 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.