NPIMap

Individual provider Active NPI

Thomas Wannenburg, MD

  • Clinical Cardiac Electrophysiology Physician
  • Knoxville, TN
National Provider Identifier
1346225380
Registry record updated Dec 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
52414 Issued in TN
Practice address
9320 Park West Blvd
Knoxville, TN 37923-4301
Phone
(865) 373-7100
Fax
(865) 373-7101
NPI assigned
Dec 13, 2005
Last updated
Dec 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 34761 NC
Clinical Cardiac Electrophysiology Physician 207RC0001X 34761 NC
Clinical Cardiac Electrophysiology Physician 207RC0001X 52414 TN Primary

Addresses

Primary practice location

9320 Park West Blvd
Knoxville, TN 37923-4301

Mailing address

9320 Park West Blvd
Knoxville, TN 37923-4301
Phone (865) 373-7100

Other identifiers 10

IdentifierTypeStateIssuer
60067968OtherRR MEDICARE
8985591MedicaidNC
2005393000MedicaidWV
8490OtherPARTNERS
5692360OtherAETNA
Q24553MedicaidSC
6013228MedicaidVA
60616OtherMEDCOST
85591OtherBCBS
Q016063MedicaidTN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wannenburg.thomas@covenanthealth.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA, TN3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20110920000378 FL Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 6608904420 Reassigns benefits to 1 organization
I20111003000542 GA Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Cardiac Surgery 6608904420 Reassigns benefits to 1 organization
I20150624002410 TN Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology) 6608904420 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology)
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical Group IncGroup PAC ID 2860305463, 363 clinicians
Parkwest Medical CenterGroup PAC ID 8527965417, 58 clinicians

Practice addresses (Care Compare)

9320 Parkwest Blvd
Knoxville, TN 37923-4301
Phone (865) 373-7100

9352 Park W Blvd
Knoxville, TN 37923-4325
Phone (865) 694-5700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as individual
Quality
87.38
Promoting interoperability
100
Improvement activities
30

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair88

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Sep 19, 2011 Accepting new patients
Parkwest Medical Center CurrentSince May 11, 2015 Accepting new patients
Covenant Medical Group, Inc. Cardiovascular Disease CurrentSince May 11, 2015 Accepting new patients
University of Florida Jacksonville Physicians Inc Cardiovascular Disease CurrentSince Jul 1, 2020 Accepting new patients
Covenant Medical Group, Inc CurrentSince May 11, 2015 Accepting new patients
Parkwest Medical Center Past Accepting new patients

Locations

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

201 Lakeshore Pt
Ste B
Saint Marys, GA 31558
Phone (912) 729-6821

9320 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-7100

9330 Park West Blvd
Ste 402
Knoxville, TN 37923
Phone (865) 690-3003

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

Dept 888179
Knoxville, TN 37995

111 Clyde St
Loudon, TN 37774
Phone (865) 458-1554

Interoperability endpoints

  • Direct secure messaging: wannenburg.thomas@covenanthealth.cernerdirect.com

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 4

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": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1346225380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9320 PARK WEST BLVD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234301",
            "telephone_number": "865-373-7100",
            "fax_number": "865-373-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9320 PARK WEST BLVD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234301",
            "telephone_number": "865-373-7100",
            "fax_number": "865-373-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANNENBURG",
        "first_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NC",
            "license": "34761",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NC",
            "license": "34761",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "TN",
            "license": "52414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "60067968",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8985591",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2005393000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "8490",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5692360",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q24553",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6013228",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "60616",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "85591",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q016063",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wannenburg.thomas@covenanthealth.cernerdirect.com",
            "affiliation": "N",
            "address_1": "9320 Park West Blvd",
            "city": "Knoxville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "379234301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.