Individual provider Active NPI

Allix Reeder, PA-C

  • Physician Assistant
  • Knoxville, TN
National Provider Identifier
1174065817
Registry record updated Jul 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3146 Issued in TN
Practice address
9430 Park West Blvd Ste 310
Knoxville, TN 37923-4203
Phone
(865) 690-5263
Fax
(865) 588-3740
NPI assigned
Nov 11, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 3146 TN
Physician Assistant 363A00000X 3146 TN Primary

Addresses

Primary practice location

9430 Park West Blvd Ste 310
Knoxville, TN 37923-4203

Mailing address

P.O. Box 52948
Knoxville, TN 37950-2948
Phone (865) 306-5708

Other identifiers 2

IdentifierTypeStateIssuer
103I973966OtherTNMEDICARE
Q026756MedicaidTN

Other names 1

  • Allix Bullock Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170301002417 TN Practitioner - Physician Assistant 2365726809 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Surgical Associates PLLCGroup PAC ID 1254224181, 61 clinicians

Practice addresses (Care Compare)

9352 Parkwest Blvd
Knoxville, TN 37923-4325
Phone (865) 690-5263

9430 Parkwest Blvd
Suite 310
Knoxville, TN 37923-4203
Phone (865) 690-5263

Hospital & facility affiliations

  • Parkwest Medical Center Hospital, Knoxville, TN, CCN 440173

Merit-based Incentive Payment System (MIPS)

Final score
83.3 of 100Reported as group
Quality
64.09
Promoting interoperability
98
Improvement activities
40
Cost
77.69

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Surgical Associates, PLLC CurrentSince Oct 1, 2017 Accepting new patients

Locations

6408 Papermill Dr
Ste 220
Knoxville, TN 37919
Phone (865) 306-5675

6408 Papermill Dr
Knoxville, TN 37919
Phone (865) 306-5680

9430 Park West Blvd
Ste 310
Knoxville, TN 37923
Phone (865) 984-3413

9330 Park West Blvd
Ste 508
Knoxville, TN 37923
Phone (865) 691-1115

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71045

Organizations & group practices 2

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 1

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": "1478822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594684800000",
    "number": "1174065817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 52948",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379502948",
            "telephone_number": "865-306-5708",
            "fax_number": "865-584-7712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9430 PARK WEST BLVD STE 310",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234203",
            "telephone_number": "865-690-5263",
            "fax_number": "865-588-3740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REEDER",
        "first_name": "ALLIX",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-11",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "3146",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "3146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "103I973966",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q026756",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALLIX",
            "last_name": "BULLOCK",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.