Individual provider Active NPI

Connor Priddy, MD

  • Emergency Medicine Physician
  • San Diego, CA
National Provider Identifier
1205417912
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
71270 Issued in TN
Practice address
34800 Bob Wilson Drive San Diego Ca 92134
San Diego, CA 92134-3902
Phone
(619) 532-6400
NPI assigned
Apr 15, 2021
Last updated
Jun 27, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 71270 TN Primary

Addresses

Primary practice location

34800 Bob Wilson Drive San Diego Ca 92134
San Diego, CA 92134-3902

Mailing address

34800 Bob Wilson Dr
San Diego, CA 92134-1098

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241011001528 TN Practitioner - Emergency Medicine 3476085705 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71270TNMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tennessee River Physicians, PLLC Emergency Medicine Current Accepting new patients
Tennessee River Physicians, PLLC Emergency Medicine CurrentSince Sep 1, 2024 Accepting new patients
Tennessee River Physicians, PLLC Emergency Medicine CurrentSince Sep 1, 2024 Accepting new patients

Locations

975 E 3rd St
Chattanooga, TN 37403
Phone (423) 266-1499

16931 Rankin Ave
Dunlap, TN 37327
Phone (423) 949-5100

71 Wheelertown Ave
Pikeville, TN 37367
Phone (423) 447-2112

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1618444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1205417912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921341098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DRIVE SAN DIEGO CA 92134",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921343902",
            "telephone_number": "619-532-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIDDY",
        "first_name": "CONNOR",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-15",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "71270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.