Active NPI
Richard Killeen
- General Practice Physician
- Chattanooga, TN
National Provider Identifier
1356962955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 69106
- Practice address
- 3931 Inlet Loop
Chattanooga, TN 37416-3087 - Phone
- (502) 644-0769
- NPI assigned
- May 5, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 69106 | TN | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
3931 Inlet Loop
Chattanooga, TN 37416-3087
Mailing address
3931 Inlet Loop
Chattanooga, TN 37416-3087
Phone (502) 644-0769
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695686400000",
"number": "1356962955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3931 INLET LOOP",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374163087",
"telephone_number": "502-644-0769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3931 INLET LOOP",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374163087",
"telephone_number": "502-644-0769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILLEEN",
"first_name": "RICHARD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-05-05",
"last_updated": "2023-09-26",
"certification_date": "2023-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "TN",
"license": "69106",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.