Blaine L. Enderson, M.D.

Primary specialty

Trauma Surgery PhysicianTaxonomy code 2086S0127X

License

MD0000018190 Issued in TN

Practice address

1924 Alcoa Hwy
U114
Knoxville, TN 37920-1511

Phone

(865) 305-9340

Fax

(865) 305-9231

NPI assigned

Jun 14, 2006

Last updated

Sep 27, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• University Health System, Inc

  dba UT Internal Medicine Pellissippi

  • Internal Medicine Physician
  • Knoxville, TN
  • NPI 1790738763
  Medicare reassignment NPD
• University Health System Inc

  dba University Thoracic Surgeons

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Knoxville, TN
  • NPI 1306609748
  NPD
• University Health System, Inc

  dba Infectious Disease

  • Internal Medicine Physician
  • Knoxville, TN
  • NPI 1245440775
  NPD
• University General Surgeons, P. C.

  • Trauma Surgery Physician
  • Knoxville, TN
  • NPI 1942243167
  NPD (past)

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317081600000",
    "number": "1346283553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 440473",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372440473",
            "telephone_number": "865-670-6199",
            "fax_number": "865-670-6188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1924 ALCOA HWY",
            "address_2": "U114",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379201511",
            "telephone_number": "865-305-9340",
            "fax_number": "865-305-9231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENDERSON",
        "first_name": "BLAINE",
        "middle_name": "L.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2011-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "TN",
            "license": "MD0000018190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3028291",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3028290",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Latonya Emory
• Susana R Enciso, CNIM
• Encore Infusion Management, LLC
• Encore Infusion of Tennessee PC (Encore Infusion)
• Encore Wound Care -Tennessee LLC
• Endocrinology Consultants of East TN
• Endomed Inc.
• Endoscopy Center of Knoxville LP (The Endoscopy Center West)
• Endoscopy Center of Knoxville LP (The Endoscopy Center)
• Energy Employees Wellness PLLC

• Trauma Surgery Physician in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Trauma Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.