NPIMap

Organization Active NPI

Bristol Surgical Associates PC

  • Surgery Physician
  • Bristol, TN
National Provider Identifier
1811066947
Registry record updated Feb 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
BRISTOL SURGICAL ASSOCIATES PC
Practice address
1 Medical Park Blvd
250 West
Bristol, TN 37620-7430
Phone
(423) 844-6620
Fax
(423) 844-6627
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2014

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

Authorized official

Name
Ms. Johnna Borders
Title
Administrator
Phone
(423) 844-6620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

1 Medical Park Blvd
250 West
Bristol, TN 37620-7430

Mailing address

1 Medical Park Blvd
250 West
Bristol, TN 37620-7430
Phone (423) 844-6620

Other identifiers 6

IdentifierTypeStateIssuer
022276800OtherTNBLACK LUNG GROUP
0636398OtherTNUMWA GROUP
F03906748OtherTNCHAMPUS GROUP
093410OtherTNANTHEM BCBS VA GROUP
CA8128OtherTNRAILROAD MEDICARE GROUP
3386543MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080116000673 TN Part B Supplier - Clinic/Group Practice 7416038377 Receives reassigned benefits from 9 practitioners
Practice locations: Bristol, TN

National Provider Directory

National Provider Directory

Locations

28 Midway St
Ste 210
Bristol, TN 37620

1 Medical Park Blvd
Ste 250
Bristol, TN 37620
Phone (423) 844-6620

981 Volunteer Pkwy
Ste B
Bristol, TN 37620
Phone (423) 573-8100

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392681600000",
    "number": "1811066947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK BLVD",
            "address_2": "250 WEST",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207430",
            "telephone_number": "423-844-6620",
            "fax_number": "423-844-6627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK BLVD",
            "address_2": "250 WEST",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207430",
            "telephone_number": "423-844-6620",
            "fax_number": "423-844-6627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL SURGICAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2014-02-18",
        "status": "A",
        "authorized_official_last_name": "BORDERS",
        "authorized_official_first_name": "JOHNNA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "423-844-6620",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG GROUP",
            "identifier": "022276800",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA GROUP",
            "identifier": "0636398",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS GROUP",
            "identifier": "F03906748",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS VA GROUP",
            "identifier": "093410",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CA8128",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3386543",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2014; 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.