NPIMap

Organization Active NPI

CRMC Mso Sub 1, Incorporated

Doing business as Tennessee Heart

  • Specialist
  • Cookeville, TN
National Provider Identifier
1972648319
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CRMC MSO SUB 1, INCORPORATED
Doing business as
Tennessee Heart
Practice address
228 W. 4TH Street
Suite 200
Cookeville, TN 38501
Phone
(931) 372-0405
Fax
(931) 372-0463
NPI assigned
Feb 21, 2007
Last updated
Jul 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Authorized official

Name
Marilyn C Key
Title
Ceo
Phone
(931) 783-2481

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X NU
Nurse Practitioner 363L00000X NU
Specialist 174400000X NU Primary

Addresses

Primary practice location

228 W. 4TH Street
Suite 200
Cookeville, TN 38501

Mailing address

PO Box 305172
Department 92
Nashville, TN 37230-5172
Phone (931) 372-0405

Other practice location 1

310 Oak St
Livingston, TN 38570-1729
Phone (931) 403-0559

Other practice location 2

106 Henry Ave
Crossville, TN 38555-4470
Phone (931) 783-4770

Other identifiers 1

IdentifierTypeStateIssuer
3732135MedicaidTN

Other names 1

  • Tennessee Heart Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051208000043 TN Part B Supplier - Clinic/Group Practice 1052332830 Receives reassigned benefits from 36 practitioners
Practice locations: Cookeville, TN; Crossville, TN; Livingston, TN
O20141201000970 KY Part B Supplier - Clinic/Group Practice 1052332830 Receives reassigned benefits from 1 practitioner
Practice locations: Albany, KY

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

146 S Willow Ave
#A
Cookeville, TN 38501
Phone (931) 646-0808

228 W 4th St
Ste 200
Cookeville, TN 38501
Phone (931) 372-0405

106 Henry St
Crossville, TN 38555
Phone (931) 783-4770

Dept 888046
Knoxville, TN 37995

310 Oak St
Livingston, TN 38570
Phone (931) 403-0559

207 E Bockman Way
Ste B
Sparta, TN 38583
Phone (931) 836-6461

Practitioners & affiliated clinicians

Practitioners 43

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.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721088000000",
    "number": "1972648319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 305172",
            "address_2": "DEPARTMENT 92",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372305172",
            "telephone_number": "931-372-0405",
            "fax_number": "931-372-0463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 W. 4TH STREET",
            "address_2": "SUITE 200",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "38501",
            "telephone_number": "931-372-0405",
            "fax_number": "931-372-0463"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 Oak St",
            "address_purpose": "LOCATION",
            "city": "Livingston",
            "state": "TN",
            "postal_code": "385701729",
            "country_code": "US",
            "telephone_number": "931-403-0559",
            "fax_number": "931-403-0561",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "106 Henry Ave",
            "address_purpose": "LOCATION",
            "city": "Crossville",
            "state": "TN",
            "postal_code": "385554470",
            "country_code": "US",
            "telephone_number": "931-783-4770",
            "fax_number": "931-484-9616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CRMC MSO SUB 1, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A",
        "authorized_official_last_name": "KEY",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "931-783-2481"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3732135",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tennessee Heart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; 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.