Jairo Alfredo Fortich, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

40307 Issued in TN

Practice address

140 Market Place Blvd Ste E
Knoxville, TN 37922-2337

Phone

(865) 212-2211

Fax

(833) 314-0589

NPI assigned

Jun 9, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• App of Tennessee Ed, PLLC

  • Emergency Medicine Physician
  • Maryville, TN
  • NPI 1003230236
  Medicare reassignment NPD
• App of Tennessee HM, PLLC

  • Hospitalist Physician
  • Shelbyville, TN
  • NPI 1396160768

  Emergency Medicine

  Medicare reassignment NPD
• Emergency Coverage, LLC

  dba Emergency Coverage Corporation of TeamHealth

  • Family Medicine Physician
  • Newport, TN
  • NPI 1427005008

  Emergency Medicine

  Medicare reassignment NPD
• Metro Family Care, LLC

  dba Valor Medical

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1659716934
  Medicare reassignment NPD
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  TN

  Medicare reassignment
• Trinity Medical of Kentucky

  • Emergency Medicine Physician
  • Knoxville, TN
  • NPI 1437568219
  Authorized official Same address or phone
• Bearden Behavioral Health, LLC

  • Exclusive Provider Organization
  • Knoxville, TN
  • NPI 1700223773
  NPD (past)
• East Tenn Neurology CL PC

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Knoxville, TN
  • NPI 1932308293
  NPD (past)
• Emergency Coverage Services, PC

  • Nurse Practitioner
  • Lawrenceburg, TN
  • NPI 1053351593
  NPD (past)
• Metro Knoxville Hma LLC

  dba Tennova Healthcare North Knoxville Medical Center

  • General Acute Care Hospital
  • Powell, TN
  • NPI 1043292899
  NPD (past)
• Tennessee Em-I Medical Services PC

  • Physician Assistant
  • Lebanon, TN
  • NPI 1164742300
  NPD (past)
• Advanced Pediatric Specialists LLC

  • Pediatrics Physician
  • Savannah, GA
  • NPI 1073046397
  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1104867381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 MARKET PLACE BLVD STE E",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379222337",
            "telephone_number": "865-212-2211",
            "fax_number": "833-314-0589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 MARKET PLACE BLVD STE E",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379222337",
            "telephone_number": "865-212-2211",
            "fax_number": "833-314-0589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTICH",
        "first_name": "JAIRO",
        "middle_name": "ALFREDO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "40307",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "40307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fort Sanders West Op Surgery Center
• Alexandra Fort, FNP-BC
• Amber Fortenberry, LCSW
• William David Forth, DC
• Dawn M Fortich, LCSW
• Sarah McCall Fortney, M.S. CCC-SLP
• Fortress Corporation (Ft Sanders West Diagnostic Center)
• Jason Fortuna, CRNA
• Forward Physical Therapy,LLC
• Addison Foster

• Family Medicine Physician in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.