Individual provider Active NPI

Briana Roberts, PA-C

  • Physician Assistant
  • Knoxville, TN
National Provider Identifier
1013615053
Registry record updated Sep 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5379 Issued in TN
Practice address
2001 Laurel Ave Ste 204
Knoxville, TN 37916-1864
Phone
(865) 673-0288
NPI assigned
Feb 20, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5379 TN Primary

Addresses

Primary practice location

2001 Laurel Ave Ste 204
Knoxville, TN 37916-1864

Mailing address

309 N Franklin Ave Apt B
Cookeville, TN 38501-2314
Phone (910) 474-1049

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230504000746 TN Practitioner - Physician Assistant 7012372600 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Southern College of Medicine and Surgery, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Tennessee Surgical Group, P.C.Group PAC ID 2365497765, 5 clinicians

Practice addresses (Care Compare)

2001 Laurel Ave
Knoxville, TN 37916-1864
Phone (865) 673-0288

Hospital & facility affiliations

  • Fort Sanders Regional Medical Center Hospital, Knoxville, TN, CCN 440125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5379TNMDPhysician Assistant

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1676851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695340800000",
    "number": "1013615053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 N FRANKLIN AVE APT B",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012314",
            "telephone_number": "910-474-1049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 LAUREL AVE STE 204",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379161864",
            "telephone_number": "865-673-0288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "BRIANA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-20",
        "last_updated": "2023-09-22",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "5379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.