Individual provider Active NPI

Ronald Kevin Carroll, DO

  • Emergency Medicine Physician
  • Garden City, MI
National Provider Identifier
1215129515
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
0102202951 Issued in VA
Practice address
6245 Inkster Rd
Garden City, MI 48135-4001
Phone
(734) 458-4486
Fax
(734) 458-4496
NPI assigned
Aug 10, 2007
Last updated
Feb 17, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2116 TN
Emergency Medicine Physician 207P00000X 5101017465 MI
Emergency Medicine Physician 207P00000X 0102202951 VA Primary
General Practice Physician 208D00000X 5101017465 MI

Addresses

Primary practice location

6245 Inkster Rd
Garden City, MI 48135-4001

Mailing address

197 Laurel LN
Canton, MI 48187-4591
Phone (865) 776-5333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100823000727 TN Practitioner - Emergency MedicinePractitioner - Hospitalist 5193862357 Reassigns benefits to 2 organizations
I20120109000071 VA Practitioner - Emergency Medicine 5193862357 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Hospitalist
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tri-Cities Regional Emergency Physicians, PCGroup PAC ID 3678859477, 118 clinicians

Practice addresses (Care Compare)

1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 844-1121

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0102202951VAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-Cities Regional Emergency Physicians, PC Emergency Medicine CurrentSince Jun 25, 2021 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince May 20, 2016 Accepting new patients
Wellmont Medical Associates Inc CurrentSince May 20, 2016 Accepting new patients
Omni Health Services, LTD Emergency Medicine Past Accepting new patients

Locations

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

1 Medical Park Blvd
Ste 210E
Bristol, TN 37620
Phone (423) 224-4000

401 Takoma Ave
Greeneville, TN 37743
Phone (423) 639-3151

400 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-1310

105 W Stone Dr
Ste 6A
Kingsport, TN 37660
Phone (423) 408-7220

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

130 W Ravine Rd
Kingsport, TN 37660
Phone (423) 224-3150

1519 Main St
Sneedville, TN 37869
Phone (423) 733-5000

1990 Holton Ave E
Big Stone Gap, VA 24219
Phone (276) 523-3111

100 15th St NW
Norton, VA 24273
Phone (276) 439-1000

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 3

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": "1186704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1215129515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "197 LAUREL LN",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481874591",
            "telephone_number": "865-776-5333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6245 INKSTER RD",
            "city": "GARDEN CITY",
            "state": "MI",
            "postal_code": "481354001",
            "telephone_number": "734-458-4486",
            "fax_number": "734-458-4496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "RONALD",
        "middle_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-10",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "2116",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101017465",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0102202951",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "5101017465",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden City, MI

Sources for this page

Verify at the official NPI Registry.