Cumberland Kidney Specialist

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

CUMBERLAND KIDNEY SPECIALIST

Practice address

117 N Hickory Ave Ste 200
Cookeville, TN 38501-2424

Phone

(931) 646-0880

Fax

(866) 834-5618

NPI assigned

Mar 6, 2009

Last updated

Aug 11, 2022By 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

Anju Mendiratta, M.D.NPI 1578533105

Title

Physician / Sole MBR

Phone

(931) 646-0880

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Dialysis Care Center Crossville LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Crossville, TN
  • NPI 1720431984

  Member Of

  NPD member

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18263/brand/1/csg/1/fhir/r4

Practitioners 11

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.

• Anju Mendiratta, MD

  • Nephrology Physician
  • Cookeville, TN
  • NPI 1578533105

  Single Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Rebecca Jones, APN

  • Family Nurse Practitioner
  • Cookeville, TN
  • NPI 1578971156
  Medicare reassignment Care Compare group NPD
• Tracie Adams, FNP-C

  • Primary Care Nurse Practitioner
  • Brentwood, TN
  • NPI 1790357564
  Medicare reassignment NPD
• Boonphiphop Boonpheng, M.D.

  • Nephrology Physician
  • Cookeville, TN
  • NPI 1659723104
  Medicare reassignment NPD
• Katelyn Marie Jones, APRN, FNP-C

  • Family Nurse Practitioner
  • Brentwood, TN
  • NPI 1649986035
  Medicare reassignment NPD
• Kaitlyn Brooke Mashburn, NP

  • Family Nurse Practitioner
  • Cookeville, TN
  • NPI 1427634583
  Medicare reassignment NPD
• Sharmil Suma Kumaran, M.D.

  • Nephrology Physician
  • Elkins, WV
  • NPI 1780175844

  TN

  Medicare reassignment NPD
• Briana Roberts, PA-C

  • Physician Assistant
  • Knoxville, TN
  • NPI 1013615053
  Medicare reassignment
• William Flowers, FNP-C

  • Family Nurse Practitioner
  • Jamestown, TN
  • NPI 1962855445
  NPD (past)
• Priscilla Martin, FNP

  • Primary Care Nurse Practitioner
  • Cookeville, TN
  • NPI 1548046857
  NPD (past)
• Tyler Cade York, FNP

  • Family Nurse Practitioner
  • Cookeville, TN
  • NPI 1477471746
  NPD (past)

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

{
    "created_epoch": "1236297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660176000000",
    "number": "1922248756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 N HICKORY AVE STE 200",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012424",
            "telephone_number": "931-646-0880",
            "fax_number": "931-646-0884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 N HICKORY AVE STE 200",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012424",
            "telephone_number": "931-646-0880",
            "fax_number": "866-834-5618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND KIDNEY SPECIALIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-06",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A",
        "authorized_official_last_name": "MENDIRATTA",
        "authorized_official_first_name": "ANJU",
        "authorized_official_title_or_position": "PHYSICIAN / SOLE MBR",
        "authorized_official_telephone_number": "931-646-0880",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "TN",
            "license": "040111",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rad Maxey Cuebas, RN
• Rebecca Culver, LMSW
• Cumberland Addiction & Recovery Program, PLLC
• Cumberland Back Pain Clinic PC (McMinnville Pain Clinic)
• Cumberland Imaging Associates, PC
• Cumberland Neurological and Spinal Surgery (Tier 1 Neurosurgery)
• Cumberland Rehabilitation Services LLC
• Astria Cunningham
• Cheryl A Cunningham, PA-C
• Cura Partners, LLC (Addus HomeCare)

• Nephrology Physician in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Nephrology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; 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.