NPIMap

Individual provider Active NPI

Donald O. Ezuteh, M.D.

  • Internal Medicine Physician
  • Lebanon, TN
National Provider Identifier
1053453795
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
40016 Issued in TN
Practice address
1436 W Main St
Lebanon, TN 37087-1323
Phone
(615) 965-6108
Fax
(877) 504-1444
NPI assigned
Feb 12, 2007
Last updated
Apr 21, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 40016 TN Primary

Addresses

Primary practice location

1436 W Main St
Lebanon, TN 37087-1323

Mailing address

1436 W Main St
Lebanon, TN 37087-1323
Phone (615) 965-6108

Other identifiers 1

IdentifierTypeStateIssuer
3334191MedicaidTN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address donald.ezuteh.1@29601.direct.athenahealth.com Direct

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
I20050920001242 TN Practitioner - Internal MedicinePractitioner - Emergency Medicine 0840224739 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Emergency Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1436 W Main St
Lebanon, TN 37087-1323
Phone (615) 965-6108

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40016TNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Centerwell Senior Primary Care TN PC Internal Medicine CurrentSince Apr 28, 2025 Accepting new patients
Centerwell Senior Primary Care TN PC Internal Medicine CurrentSince Apr 28, 2025 Accepting new patients
Anova Medical Associates, PLC CurrentSince Jun 1, 2019 Accepting new patients
Emergency Physicians at Trousdale PLLC Past Accepting new patients
Sumner Regional Medical Center LLC Internal Medicine Past Accepting new patients
Centerwell Senior Primary Care TN PC Internal Medicine Past Accepting new patients

Locations

6101 Waterford District Dr
Ste 200
Miami, FL 33126
Phone (407) 533-6836

1156 Nashville Pike
Gallatin, TN 37066
Phone (615) 989-1088

300 Steam Plant Rd
Ste 300
Gallatin, TN 37066
Phone (615) 451-9200

555 Hartsville Pike
Gallatin, TN 37066
Phone (615) 328-5067

1436 W Main St
Lebanon, TN 37087
Phone (615) 965-6108

4901 Nolensville Rd
Nashville, TN 37211
Phone (615) 760-5022

7643 Highway 70 S
Nashville, TN 37221
Phone (615) 334-4635

Interoperability endpoints

  • Direct secure messaging: donald.ezuteh.1@29601.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 4

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": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1053453795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1436 W MAIN ST",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370871323",
            "telephone_number": "615-965-6108",
            "fax_number": "877-504-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 W MAIN ST",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370871323",
            "telephone_number": "615-965-6108",
            "fax_number": "877-504-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZUTEH",
        "first_name": "DONALD",
        "middle_name": "O.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "40016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3334191",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "donald.ezuteh.1@29601.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1436 W Main St",
            "city": "Lebanon",
            "state": "TN",
            "country_code": "US",
            "postal_code": "370871323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lebanon, TN

Sources for this page

Verify at the official NPI Registry.