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CROSSVILLE MEDICAL GROUP PA
NPI 1053414698
Clinic/Center - Multi-Specialty in Crossville, TN

Active since September 07, 2006CLIA Certified · 2 labs
100 LANTANA RD, SUITE 202, CROSSVILLE, TN 38555(931) 484-5141(931) 484-5620 Get Directions Write a Review

NPPES record last updated: November 19, 2009. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Crossville Medical Group Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CROSSVILLE MEDICAL GROUP PA (NPI 1053414698) is a healthcare organization registered as a multi-specialty in Crossville, Tennessee and active in the NPI registry since September 2006. The organization holds 2 active CLIA laboratory certificates and lists Gary Burton, Administrator, as its authorized official.

NPPES Registry Identity

NPI1053414698
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameCROSSVILLE MEDICAL GROUP PA
Location Address100 LANTANA RD, SUITE 202Crossville, TN 38555-1903
Mailing Address100 Lantana Rd, Suite 202Crossville, TN 38555-1903 · (931) 484-5141 · Fax (931) 484-5620
Phone(931) 484-5141
Fax(931) 484-5620
Organization SubpartNo
Authorized OfficialGary BurtonAdministrator · (931) 484-5141
Enumeration DateSeptember 7, 2006
Last NPPES UpdateNovember 19, 2009
✔ NPI 1053414698 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
100 LANTANA RD, Crossville, TN 38555
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Other Identifiers 2

Medicaid3370906TN
Medicare PIN3370906TN

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 44D0316201

Crossville Medical Group Dba Covenant Medical Group · Crossville, TN
Active · expires Nov 3, 2026
CLIA Number44D0316201
Laboratory TypePhysician Office
Certificate Effective DateNovember 4, 2024
Certificate Expiration DateNovember 3, 2026
Laboratory DirectorDr. Elizabeth M. Petty
Laboratory Phone(931) 484-5141
Laboratory LocationCrossville Medical Group Dba Covenant Medical Group100 Lantana Road Suite 202, Crossville, TN 38555
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 44D2013655

Covenant Medical Management Dba Crossville Medical Group · Fairfield Glade, TN
Active · expires Sep 22, 2026
CLIA Number44D2013655
Laboratory TypePhysician Office
Certificate Effective DateSeptember 23, 2024
Certificate Expiration DateSeptember 22, 2026
Laboratory DirectorDr. Elizabeth M. Petty
Laboratory Phone(931) 484-5141
Laboratory LocationCovenant Medical Management Dba Crossville Medical Group132 Stonehenge Dr, Fairfield Glade, TN 38558
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. BRUCE CORWYN RAFFEL MD
Surgery (Plastic and Reconstructive Surgery)
100 LANTANA RD, SUITE 202
CROSSVILLE, TN 38555
Cumberland County (931) 484-5141
MR. MARK ALAN FOX MD
Surgery
100 LANTANA RD, SUITE 202
CROSSVILLE, TN 38555
Cumberland County (931) 484-5141
DR. TAMARA JEAN COLLINS M.D.
Internal Medicine
100 LANTANA RD, SUITE 202
CROSSVILLE, TN 38555
Cumberland County (931) 484-5141
MR. ROBERT E NICHOLS MD
Internal Medicine
100 LANTANA RD, SUITE 202
CROSSVILLE, TN 38555
Cumberland County (931) 484-5141
MR. GARLAND A WILSON MD
Family Medicine
100 LANTANA RD, SUITE 202
CROSSVILLE, TN 38555
Cumberland County (931) 484-5141
MRS. ELIZABETH M PETTY MD
Internal Medicine
100 LANTANA RD, SUITE 202
CROSSVILLE, TN 38555
Cumberland County (931) 484-5141
DAWN ONEAL RNFA
Registered Nurse (Registered Nurse First Assistant)
100 LANTANA RD, SUITE 202
CROSSVILLE, TN 38555
Cumberland County (931) 484-5141
JOHN SMITH PROFESSIONAL PHARMACY, INC.
Pharmacy (Long Term Care Pharmacy)
100 LANTANA RD, STE. 201
CROSSVILLE, TN 38555
Cumberland County (931) 484-1434

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Crossville Medical Group PA's NPI number?

The NPI number for Crossville Medical Group PA is 1053414698. It was assigned to this organization in the NPPES registry on September 7, 2006.

Where is Crossville Medical Group PA located?

Crossville Medical Group PA is located at 100 Lantana Rd Suite 202, Crossville, TN 38555. The listed phone number is (931) 484-5141.

What is Crossville Medical Group PA's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Does Crossville Medical Group PA hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Crossville Medical Group PA was last updated on November 19, 2009. NPI Profile syncs with the weekly NPPES data releases published by CMS.