Active NPI
Samuel Elliott
- Physician Assistant
- Sevierville, TN
National Provider Identifier
1093577785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5887
- Practice address
- 502 Winfield Dunn Pkwy
Sevierville, TN 37876-5509 - Phone
- (423) 715-4168
- NPI assigned
- Jan 29, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5887 | TN | Primary |
Addresses
Primary practice location
502 Winfield Dunn Pkwy
Sevierville, TN 37876-5509
Mailing address
7813 Senate LN
Knoxville, TN 37931-4528
Phone (423) 715-4168
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5887 | TN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707609600000",
"number": "1093577785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7813 SENATE LN",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379314528",
"telephone_number": "423-715-4168"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "502 WINFIELD DUNN PKWY",
"city": "SEVIERVILLE",
"state": "TN",
"postal_code": "378765509",
"telephone_number": "423-715-4168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "SAMUEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-29",
"last_updated": "2024-02-11",
"certification_date": "2024-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TN",
"license": "5887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sevierville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.