NPIMap

Organization Active NPI

Crossroads Treatment Centers of Tennessee, PC

  • Clinic/Center
  • Hermitage, TN
National Provider Identifier
1801550421
Registry record updated Oct 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
CROSSROADS TREATMENT CENTERS OF TENNESSEE, PC
Practice address
5045 Old Hickory Blvd Ste 101
Hermitage, TN 37076-2581
Phone
(800) 805-6989
NPI assigned
Oct 29, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2021

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

Authorized official

Name
Rupert James McCormac, MD
Title
President
Phone
(864) 527-3145

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Community/Behavioral Health Agency 251S00000X
Clinic/Center 261Q00000X Primary
Methadone Clinic 261QM2800X

Addresses

Primary practice location

5045 Old Hickory Blvd Ste 101
Hermitage, TN 37076-2581

Mailing address

200 E Broad St Ste 300
Greenville, SC 29601-2891
Phone (800) 805-6989

Other names 1

  • Crossroads Treatment Center Hermitage Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200213002831 TN Part B Supplier - Clinic/Group Practice 6204262025 Receives reassigned benefits from 45 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tullahoma, TN; Sparta, TN; Oak Ridge, TN; Newport, TN; Morristown, TN; Johnson City, TN; Knoxville, TN; Jacksboro, TN…

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635465600000",
    "number": "1801550421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E BROAD ST STE 300",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012891",
            "telephone_number": "800-805-6989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5045 OLD HICKORY BLVD STE 101",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370762581",
            "telephone_number": "800-805-6989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS TREATMENT CENTERS OF TENNESSEE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-29",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A",
        "authorized_official_last_name": "MCCORMAC",
        "authorized_official_first_name": "RUPERT",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-527-3145",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Treatment Center Hermitage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hermitage, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.