Cordova Medical & Cosmedic Solutions, PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

MD15815 Issued in TN

Legal business name

CORDOVA MEDICAL & COSMEDIC SOLUTIONS, PC

Practice address

1025 Cordova Station Ave
Cordova, TN 38018-6318

Phone

(901) 507-4400

Fax

(901) 756-5836

NPI assigned

Mar 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Marc J. Crupie, M.D.NPI 1467543140

Title

President

Phone

(901) 507-4400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Germantown Family Practice, PC Former legal business name

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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 1

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

• Marc J. Crupie, M.D.

  • Family Medicine Physician
  • Cordova, TN
  • NPI 1467543140

  TN

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200355200000",
    "number": "1831229475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4438",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380884438",
            "telephone_number": "901-507-4400",
            "fax_number": "901-756-5836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 CORDOVA STATION AVE",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380186318",
            "telephone_number": "901-507-4400",
            "fax_number": "901-756-5836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORDOVA MEDICAL & COSMEDIC SOLUTIONS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2008-01-15",
        "status": "A",
        "authorized_official_last_name": "CRUPIE",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-507-4400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": "MD15815",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "3144579",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Germantown Family Practice, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Cordova Family Dental
• Cordova Family Dental, PLLC
• Cordova Family Dentistry
• Cordova Healthcare, LLC
• Cordova Internal Medicine, PLLC
• Cordova Operating Group LLC
• Cordova Pain Specialists, PLLC
• Cordova Pediatrics PLLC
• Cordova Psychiatric Associates
• Cordova Senior Living, LLC

• All providers in Cordova, TN
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2008; 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.