The Cookeville Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0000000036 Issued in TN

Legal business name

THE COOKEVILLE SURGERY CENTER

Practice address

100 W 4TH St
Suite 100
Cookeville, TN 38501-2448

Phone

(931) 526-8115

Fax

(931) 526-7619

NPI assigned

Oct 3, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cindy D Smith

Title

Business Manager

Phone

(931) 526-8115

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Listed as

The Cookeville Surgery CenterCCN 44C0001022

Medicare certification status

ActiveFrom the Provider of Services file

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 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Scott H Keith, MD

  • Specialist
  • Cookeville, TN
  • NPI 1184669061
  NPD
• Mark D Kriskovich, M.D.

  • Specialist
  • Cookeville, TN
  • NPI 1619086626
  NPD
• Evan Sanford, M.D.

  • Otolaryngology Physician
  • Cookeville, TN
  • NPI 1871989350
  NPD
• Karen Sue Brandt, MA, CCC-A

  • Audiologist-Hearing Aid Fitter
  • Cookeville, TN
  • NPI 1972899722
  NPD (past)
• Allison Davenport, PA-C

  • Physician Assistant
  • Murfreesboro, TN
  • NPI 1487100749
  NPD (past)
• Samuel Floren, MD

  • Otolaryngology Physician
  • Cookeville, TN
  • NPI 1588293070
  NPD (past)
• Aaron A Jones, CRNA

  • Certified Registered Nurse Anesthetist
  • Cookeville, TN
  • NPI 1215015706
  NPD (past)
• Charles Edward Jordan III, MD

  • Specialist
  • Cookeville, TN
  • NPI 1285682419
  NPD (past)
• Andrea Elizabeth Kooch, PA-C

  • Physician Assistant
  • Knoxville, TN
  • NPI 1275174013
  NPD (past)
• Thomas L Lawrence, MD

  • Specialist
  • Cookeville, TN
  • NPI 1699723825
  NPD (past)
• Frederick Bronn Rayne, MD

  • Specialist
  • Cookeville, TN
  • NPI 1235197245
  NPD (past)
• Grant T Rohman, MD

  • Otolaryngology Physician
  • Cookeville, TN
  • NPI 1356542476
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831283860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W 4TH ST",
            "address_2": "SUITE 100",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012448",
            "telephone_number": "931-526-8115",
            "fax_number": "931-526-7619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W 4TH ST",
            "address_2": "SUITE 100",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012448",
            "telephone_number": "931-526-8115",
            "fax_number": "931-526-7619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE COOKEVILLE SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "931-526-8115"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TN",
            "license": "0000000036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3287222",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tennessee Radiology Associates, PLLC (Columbia Diagnostic Imaging, PLLC)
• Tennessee Sports Medicine, PC
• Tennessee Tech University Center for Addiction Prevention and Support
• Tennessee Therapy & Balance Center, LLC
• Ilona Terral, LPC-MHSP
• Therapeutic Interventions, Inc.
• Therapy Solutions, PC
• Lydia Ann Thoman, BA
• Lori Ann Thomas-Steward, D.O.
• Beverly Boykin Thomas, M.D.

• Ambulatory Surgical Clinic/Center in Cookeville, TN
• Providers in Cookeville, 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 Aug 22, 2020; 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.