Charles Wayne Carroll, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

30647 Issued in TN

Practice address

405 Scenic Dr Ste a
Rogersville, TN 37857-2441

Phone

(423) 921-3490

NPI assigned

Jan 25, 2022

Last updated

Feb 22, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tri-Cities Regional Emergency Physicians, PCGroup PAC ID 3678859477, 118 clinicians

Wellmont Medical Associates IncGroup PAC ID 8123291739, 432 clinicians

Blue Ridge Medical Management CorporationGroup PAC ID 9739099441, 283 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Greeneville Community Hospital Hospital, Greeneville, TN, CCN 440050
• Hawkins County Memorial Hospital Hospital, Rogersville, TN, CCN 440032

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Blue Ridge Medical Management Corporation

  dba First Assist Urgent Care

  • Urgent Care Clinic/Center
  • Elizabethton, TN
  • NPI 1144380833
  Medicare reassignment Care Compare group NPD
• Tri-Cities Regional Emergency Physicians, PC

  • Emergency Medicine Physician
  • Johnson City, TN
  • NPI 1063950046
  Medicare reassignment Care Compare group NPD
• Wellmont Medical Associates Inc

  dba Ballad Health Medical Associates

  • Pulmonary Disease Physician
  • Bristol, TN
  • NPI 1780986257
  Medicare reassignment Care Compare group NPD
• Fast Pace Medical Clinic PLLC

  • Family Medicine Physician
  • Spring Hill, TN
  • NPI 1134452865
  Medicare reassignment NPD
• Upperline Healthcare, PC

  • Foot & Ankle Surgery Podiatrist
  • Hoover, AL
  • NPI 1538686498

  TN

  Medicare reassignment NPD
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Family Medicine Physician
  • Johnson City, TN
  • NPI 1982553756
  NPD
• Blue Ridge Medical Managgement Corporation

  dba Ballad Health Medical Associates

  • Internal Medicine Physician
  • Kingsport, TN
  • NPI 1649518309
  NPD
• Fast Pace Medical Clinic PLLC

  • Rural Health Clinic/Center
  • Chapel Hill, TN
  • NPI 1316602774
  NPD
• Wellmont Medical Associates, Inc.

  dba Ballad Health Medical Associates

  • Psychiatry Physician
  • Johnson City, TN
  • NPI 1275393522
  NPD
• Upperline Healthcare, PC

  • Foot & Ankle Surgery Podiatrist
  • Ocoee, FL
  • NPI 1326906843
  NPD

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

• Takoma Regional Hospital Inc

  dba Ballad Health Medical Associates

  • General Acute Care Hospital
  • Greeneville, TN
  • NPI 1699819003
  Care Compare affiliation
• Wellmont Hawkins County Memorial Hospital Inc

  dba Hawkins County Memorial Hospital

  • General Acute Care Hospital
  • Rogersville, TN
  • NPI 1174553598
  Care Compare affiliation

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

{
    "created_epoch": "1643068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740182400000",
    "number": "1043962541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-952-2111",
            "fax_number": "423-282-1657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 SCENIC DR STE A",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "378572441",
            "telephone_number": "423-921-3490"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1116 Highway 11 W",
            "address_purpose": "LOCATION",
            "city": "Church Hill",
            "state": "TN",
            "postal_code": "376423023",
            "country_code": "US",
            "telephone_number": "423-226-5109",
            "fax_number": "423-226-5150",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2686 W State St",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376201817",
            "country_code": "US",
            "telephone_number": "423-844-0026",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1497 W Elk Ave Ste 11",
            "address_purpose": "LOCATION",
            "city": "Elizabethton",
            "state": "TN",
            "postal_code": "376432896",
            "country_code": "US",
            "telephone_number": "423-542-8929",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "438 E Vann Rd Ste 301",
            "address_purpose": "LOCATION",
            "city": "Greeneville",
            "state": "TN",
            "postal_code": "377437202",
            "country_code": "US",
            "telephone_number": "423-636-9828",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "161 Heart Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376042607",
            "country_code": "US",
            "telephone_number": "423-282-0751",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4600 Fort Henry Dr",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376632617",
            "country_code": "US",
            "telephone_number": "423-224-3950",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 W Stone Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376606027",
            "country_code": "US",
            "telephone_number": "423-224-3701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "CHARLES",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-25",
        "last_updated": "2025-02-22",
        "certification_date": "2025-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "30647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca R Byrd, LMSW
• Christopher Lawrence Calendine, MD
• Carewell Medical, LLC
• Jada Danielle Carpenter, RBT
• Kathy Loraine Carpenter, RN
• Amanda Leann Carter
• John Lee Chambers, OD
• Cherokee Medical Clinic LLC
• Cherokee Orthotics & Medical Equipment Inc
• Cherokee Physical Therapy, Inc

• Family Nurse Practitioner in Rogersville, TN
• Providers in Rogersville, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.