NPIMap

Individual provider Active NPI

Stephen Marietta, M.D.

  • Interventional Cardiology Physician
  • Knoxville, TN
National Provider Identifier
1053301606
Registry record updated Aug 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
16657 Issued in TN
Practice address
9330 Park West Blvd
Suite 202
Knoxville, TN 37923-4308
Phone
(865) 691-4850
Fax
(865) 694-8018
NPI assigned
Oct 25, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X 16657 TN Primary
Cardiovascular Disease Physician 207RC0000X 16657 TN

Addresses

Primary practice location

9330 Park West Blvd
Suite 202
Knoxville, TN 37923-4308

Mailing address

9330 Park West Blvd
Suite 202
Knoxville, TN 37923-4308
Phone (865) 691-4850

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address marietta.stephen@covenanthealth.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040607001223 TN Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 2668454133 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
Creighton University School of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical Group IncGroup PAC ID 2860305463, 363 clinicians

Practice addresses (Care Compare)

111 Clyde St
Loudon, TN 37774-1600
Phone (865) 458-1554

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16657TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MPS-Cardiology LLC Cardiovascular Disease Current Accepting new patients
East Tennessee Heart Consultants, P.C. Cardiovascular Disease Past Accepting new patients
Parkwest Medical Center Past Accepting new patients

Locations

101 E Blount Ave
Ste 300
Knoxville, TN 37920
Phone (865) 549-7503

Interoperability endpoints

  • Direct secure messaging: marietta.stephen@covenanthealth.cernerdirect.com

Organizations & group practices 5

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 3

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": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597622400000",
    "number": "1053301606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9330 PARK WEST BLVD",
            "address_2": "SUITE 202",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234308",
            "telephone_number": "865-691-4850",
            "fax_number": "865-694-8018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9330 PARK WEST BLVD",
            "address_2": "SUITE 202",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234308",
            "telephone_number": "865-691-4850",
            "fax_number": "865-694-8018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARIETTA",
        "first_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-25",
        "last_updated": "2020-08-17",
        "certification_date": "2020-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "TN",
            "license": "16657",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TN",
            "license": "16657",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "marietta.stephen@covenanthealth.cernerdirect.com",
            "affiliation": "N",
            "address_1": "9330 Park West Blvd",
            "address_2": "Suite 202",
            "city": "Knoxville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "379234308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.