Active NPI
Keith Young, M.D.
- Family Medicine Physician
- Woodbury, TN
National Provider Identifier
1003854258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD34850
- Practice address
- 205 S McCrary St
Woodbury, TN 37190-1439 - Phone
- (615) 563-2891
- Fax
- (615) 563-4582
- NPI assigned
- Jun 2, 2006
- Last updated
- Dec 10, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD34850 | TN | Primary |
Addresses
Primary practice location
205 S McCrary St
Woodbury, TN 37190-1439
Mailing address
205 S McCrary St
Woodbury, TN 37190-1439
Phone (615) 563-2891
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10066741 | Other | AMERIGROUP/TENNCARE | |
| 3865024 | Medicaid | TN | |
| TN0101 | Other | AMERICHOICE | |
| 4019970 | Other | TN | BLUE CROSS BLUE SHIELD TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD34850 | TN | MD | Family Medicine Physician |
| 34850 | TN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Churchill Drive Emergency Physicians LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260403200000",
"number": "1003854258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 S MCCRARY ST",
"city": "WOODBURY",
"state": "TN",
"postal_code": "371901439",
"telephone_number": "615-563-2891",
"fax_number": "615-563-4582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 S MCCRARY ST",
"city": "WOODBURY",
"state": "TN",
"postal_code": "371901439",
"telephone_number": "615-563-2891",
"fax_number": "615-563-4582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "KEITH",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-02",
"last_updated": "2009-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TN",
"license": "MD34850",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP/TENNCARE",
"identifier": "10066741",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3865024",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICHOICE",
"identifier": "TN0101",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD TN",
"identifier": "4019970",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.