NPIMap

Organization Active NPI

Kingston Family Practice, P.C.

  • Family Medicine Physician
  • Kingston, TN
National Provider Identifier
1356432041
Registry record updated May 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KINGSTON FAMILY PRACTICE, P.C.
Practice address
820 W Race St
Kingston, TN 37763-2120
Phone
(865) 376-3406
Fax
(865) 376-9091
NPI assigned
Sep 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2023

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

Authorized official

Name
Dwight H Willett, M.D.NPI 1598746554
Title
President
Phone
(865) 376-3406

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

820 W Race St
Kingston, TN 37763-2120

Mailing address

820 W Race St
Kingston, TN 37763-2120
Phone (865) 376-3406

Other identifiers 3

IdentifierTypeStateIssuer
080080789OtherTNRAILROAD MEDICARE
080153049OtherTNRAILROAD MEDICARE
443961OtherTNRIVERBEND MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070611000731 TN Part B Supplier - Clinic/Group Practice 5294734182 Receives reassigned benefits from 1 practitioner
Practice locations: Kingston, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0311465Kingston Family Practice PC820 West Race Street, Kingston, TN 37763Certificate of waiverFeb 21, 2027

National Provider Directory

National Provider Directory

Locations

6230 Hospital Dr
Ste 1
Cass City, MI 48726

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683676800000",
    "number": "1356432041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 W RACE ST",
            "city": "KINGSTON",
            "state": "TN",
            "postal_code": "377632120",
            "telephone_number": "865-376-3406",
            "fax_number": "865-376-9091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 W RACE ST",
            "city": "KINGSTON",
            "state": "TN",
            "postal_code": "377632120",
            "telephone_number": "865-376-3406",
            "fax_number": "865-376-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSTON FAMILY PRACTICE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A",
        "authorized_official_last_name": "WILLETT",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "865-376-3406",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080080789",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080153049",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RIVERBEND MEDICARE",
            "identifier": "443961",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.