Jacob Martin Agner, DO – Emergency Medicine Physician

Key facts

NPI: 1285212100
Entity type: Individual (NPI type 1)
Primary specialty: Emergency Medicine Physician 207P00000X
License: 5625 (TN)
Practice address: 990 Oak Ridge Tpke
99
Oak Ridge, TN 37830-6976
Phone: (865) 835-3400
NPI assigned: Mar 31, 2021
Sex: Male
Sole proprietor: No

Organizations & group practices 1

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.

Southeastern Emergency Physicians LLC Emergency Medicine Physician · Maysville, KY · NPI 1356379382

Medicare reassignment Care Compare group NPD EMERGENCY MEDICINE · TN

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Methodist Medical Center General Acute Care Hospital · Oak Ridge, TN · NPI 1700870672

Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty: Emergency Medicine
Education: Other, 2021
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Southeastern Emergency Physicians LLC (776 clinicians)

Practice addresses (Care Compare)

990 Oak Ridge Tpke
Oak Ridge, TN 37830-6976
Phone (865) 481-1000

Hospital & facility affiliations

Methodist Medical Center of Oak Ridge Hospital · Oak Ridge, TN · CCN 440034

Medicare participation

Medicare fee-for-service enrollment: Enrolled in TN
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20241008001797	TN	Practitioner - Emergency Medicine	0941683718	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Osteopathy

State licenses

License	State	Type	Specialty
5625	TN	MD	Occupational Therapist

Practice roles

Organization	Specialty	Status	New patients
Southeastern Emergency Physicians LLC	Emergency Medicine	Current since Jul 25, 2024	Accepting new patients

Locations

1643 NW 136th Ave
Ste 100
Sunrise, FL 33323
Phone (865) 500-1325

9352 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-1000

990 Oak Ridge Tpke
#99
Oak Ridge, TN 37830
Phone (865) 835-3400

990 Oak Ridge Tpke
Oak Ridge, TN 37830
Phone (865) 481-1000

Interoperability endpoints

Direct secure messaging: jagner79459@direct.kdhealth.us

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Student in an Organized Health Care Education/Training Program	390200000X
Emergency Medicine Physician	207P00000X	5625	TN	Yes

Addresses

Primary practice location

990 Oak Ridge Tpke
99
Oak Ridge, TN 37830-6976

Mailing address

990 Oak Ridge Tpke
Oak Ridge, TN 37830-6976
Phone (865) 835-3400

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Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (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.