Endoscopy Center of Kingsport

Primary specialty

Endoscopy Clinic/CenterTaxonomy code 261QE0800X

License

0000000053 Issued in TN

Legal business name

ENDOSCOPY CENTER OF KINGSPORT

Doing business as

Sullivan Digestive Center

Practice address

2204 Pavilion Dr Ste 108
Kingsport, TN 37660-4651

Phone

(423) 392-6100

Fax

(423) 392-6159

NPI assigned

Aug 11, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Penny Leigh Lloyd

Title

Administrator

Phone

(423) 392-6100

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Sullivan Digestive Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Listed as

Endoscopy Center of KingsportCCN 44C0001038

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Darik Shane Barger, NP

  • Family Nurse Practitioner
  • Erwin, TN
  • NPI 1629011358
  NPD
• Amanda Beth Campbell, FNP

  • Family Nurse Practitioner
  • Kingsport, TN
  • NPI 1831503184
  NPD
• James W Denham, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Kingsport, TN
  • NPI 1902088644
  NPD
• Rebecca Jane Hamilton, NP

  • Nurse Practitioner
  • Kingsport, TN
  • NPI 1245226737
  NPD
• Michael Jude Sullivan, M.D.

  • Gastroenterology Physician
  • Kingsport, TN
  • NPI 1326023078
  NPD

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701129600000",
    "number": "1235140385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 PAVILION DR",
            "address_2": "SUITE 108",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604657",
            "telephone_number": "423-392-6100",
            "fax_number": "423-392-6159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 PAVILION DR STE 108",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604651",
            "telephone_number": "423-392-6100",
            "fax_number": "423-392-6159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDOSCOPY CENTER OF KINGSPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A",
        "authorized_official_last_name": "LLOYD",
        "authorized_official_first_name": "PENNY",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "423-392-6100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": "TN",
            "license": "0000000053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1000910",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3287396",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sullivandigestivecenter@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "Direct Message",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2204 Pavilion Dr Ste 108",
            "city": "Kingsport",
            "state": "TN",
            "country_code": "US",
            "postal_code": "376604651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Sullivan Digestive Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sullivan Digestive Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emeritus Corporation
• Emeritus Corporation
• Mark W Emery, MD
• Roxana Enache, PA-C
• Encompass Health Rehabilitation Hospital of Kingsport LLC
• Warren Edward English, M.D.
• Neva Gail Ennis, RN
• Wendy Ervin, PHARM.D
• Zachary Hunter Ervin, PT
• Patricia Erwin, FNP

• Endoscopy Clinic/Center in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Endoscopy Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.