Active NPI
Levi Samuel Widener
- Physician Assistant
- Marion, VA
National Provider Identifier
1306512371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 4743
- Practice address
- 245 Medical Park Dr Ste B
Marion, VA 24354 - Phone
- (276) 378-3020
- NPI assigned
- Aug 19, 2021
- Last updated
- Dec 5, 2025
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110008072 | VA | |
| Physician Assistant | 363A00000X | 4743 | TN | Primary |
Addresses
Primary practice location
245 Medical Park Dr Ste B
Marion, VA 24354
Mailing address
1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 952-2111
Other practice location 1
21371 Forsythe Rd
Bristol, VA 24202-4357
Phone (276) 525-4377
Other practice location 2
16000 Johnston Memorial Dr
Abingdon, VA 24211
Phone (276) 258-1000
Other practice location 3
58 Carroll Street
Lebanon, VA 24266
Phone (276) 883-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Lincoln Memorial University Medical Department, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1205 Snider St
B
Marion, VA 24354-4221
Phone (276) 258-1777
16000 Johnson Memorial Dr
Abingdon, VA 24211-7664
245 Medical Park Dr B
Marion, VA 24354-1100
Phone (276) 378-3020
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4743 | TN | MD | Occupational Therapist |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Internal Medicine Physician
- Abingdon, VA
- NPI 1306944350
-
- Internal Medicine Physician
- Roanoke, VA
- NPI 1407117625
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Abingdon, VA
- NPI 1104812684
-
dba Russell County Hospital
- General Acute Care Hospital
- Lebanon, VA
- NPI 1891973939
-
- General Acute Care Hospital
- Marion, VA
- NPI 1073519377
-
dba Center for Sleep Disorders at SCCH
- General Acute Care Hospital
- Marion, VA
- NPI 1194104687
-
- Durable Medical Equipment & Medical Supplies
- Marion, VA
- NPI 1750433389
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764892800000",
"number": "1306512371",
"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": "423-952-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 MEDICAL PARK DR STE B",
"city": "MARION",
"state": "VA",
"postal_code": "24354",
"telephone_number": "276-378-3020"
}
],
"practiceLocations": [
{
"address_1": "21371 Forsythe Rd",
"address_purpose": "LOCATION",
"city": "Bristol",
"state": "VA",
"postal_code": "242024357",
"country_code": "US",
"telephone_number": "276-525-4377",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "16000 Johnston Memorial Dr",
"address_purpose": "LOCATION",
"city": "Abingdon",
"state": "VA",
"postal_code": "24211",
"country_code": "US",
"telephone_number": "276-258-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "58 Carroll Street",
"address_purpose": "LOCATION",
"city": "Lebanon",
"state": "VA",
"postal_code": "24266",
"country_code": "US",
"telephone_number": "276-883-8000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WIDENER",
"first_name": "LEVI",
"middle_name": "SAMUEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-19",
"last_updated": "2025-12-05",
"certification_date": "2025-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110008072",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TN",
"license": "4743",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marion, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.