Active NPI
Michael Sean Luedeman, MD
- Family Medicine Physician
- Elizabethton, TN
National Provider Identifier
1255592390
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 66943
- Practice address
- 1505 W Elk Ave Ste 2
Elizabethton, TN 37643-2848 - Phone
- (423) 543-1261
- NPI assigned
- Jun 20, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 14495 | NV | |
| Family Medicine Physician | 207Q00000X | 66943 | TN | Primary |
Addresses
Primary practice location
1505 W Elk Ave Ste 2
Elizabethton, TN 37643-2848
Mailing address
1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 302-6565
Other practice location 1
700 N Spring St.
Caliente, NV 89008-1010
Phone (775) 726-3171 ext. 105
Other practice location 2
1497 W Elk Ave
Elizabethton, TN 37643-2895
Phone (423) 542-7420
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255592390 | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Nevada School of Medicine, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northern Maine Medical Center
Practice addresses (Care Compare)
197 E Main St
Fort Kent, ME 04743-1409
Phone (207) 834-5877
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14495 | NV | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Ridge Medical Management Corporation | Current | Accepting new patients | |
| Blue Ridge Medical Management Corporation | Past | Accepting new patients |
Locations
1021 W Oakland Ave
Ste 310
Johnson City, TN 37604
Phone (423) 302-6565
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.
-
- Urgent Care Clinic/Center
- Elizabethton, TN
- NPI 1144380833
-
- Cardiovascular Disease Physician
- Johnson City, TN
- NPI 1740227131
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Fort Kent, ME
- NPI 1568465144
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717977600000",
"number": "1255592390",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1021 W OAKLAND AVE STE 310",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376042192",
"telephone_number": "423-302-6565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 W ELK AVE STE 2",
"city": "ELIZABETHTON",
"state": "TN",
"postal_code": "376432848",
"telephone_number": "423-543-1261"
}
],
"practiceLocations": [
{
"address_1": "700 N SPRING ST.",
"address_purpose": "LOCATION",
"city": "CALIENTE",
"state": "NV",
"postal_code": "890081010",
"country_code": "US",
"telephone_number": "775-726-3171 x105",
"fax_number": "775-726-3797",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1497 W Elk Ave",
"address_purpose": "LOCATION",
"city": "Elizabethton",
"state": "TN",
"postal_code": "376432895",
"country_code": "US",
"telephone_number": "423-542-7420",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LUEDEMAN",
"first_name": "MICHAEL",
"middle_name": "SEAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-20",
"last_updated": "2024-06-10",
"certification_date": "2024-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NV",
"license": "14495",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TN",
"license": "66943",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1255592390",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elizabethton, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- 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.