Individual provider Active NPI

John R. Carder, M.D.

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Knoxville, TN
National Provider Identifier
1043246879
Registry record updated May 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
MD30444 Issued in TN
Practice address
2018 W Clinch Ave
Knoxville, TN 37916-2301
Phone
(865) 541-8000
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD30444 TN
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X MD30444 TN Primary
Emergency Medicine Physician 207P00000X 30444 TN

Addresses

Primary practice location

2018 W Clinch Ave
Knoxville, TN 37916-2301

Mailing address

1431 Centerpoint Blvd
Suite 100
Knoxville, TN 37932-1984

Other identifiers 3

IdentifierTypeStateIssuer
64720006MedicaidKY
3897179MedicaidTN
3097696OtherTNBLUE CROSS

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151026001537 TN Practitioner - Pediatric MedicinePractitioner - Emergency MedicinePractitioner - Undersea and Hyperbaric Medicine 1153630512 Reassigns benefits to 1 organization
Practice locations: Knoxville, TN

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
30444TNMDEmergency Medicine Physician
MD30444TNMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Emergency Physicians LLC Emergency Medicine CurrentSince Nov 8, 2022 Accepting new patients

Locations

1431 Centerpoint Blvd
Ste 100
Knoxville, TN 37932
Phone (865) 539-8000

9352 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-1000

2018 Clinch Ave
Knoxville, TN 37916
Phone (865) 541-8000

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431043200000",
    "number": "1043246879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 CENTERPOINT BLVD",
            "address_2": "SUITE 100",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379321984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2018 W CLINCH AVE",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379162301",
            "telephone_number": "865-541-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARDER",
        "first_name": "JOHN",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2015-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "MD30444",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "TN",
            "license": "MD30444",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "30444",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64720006",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3897179",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "3097696",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.