Kenneth W Patric Jr., MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD0000027485 Issued in TN

Practice address

403 McBrien Rd
East Ridge, TN 37412-3223

Phone

(423) 875-0700

NPI assigned

Jun 3, 2006

Last updated

May 25, 2023By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, KY, AZ, GA4 enrollments

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 4

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.

• Crossroads Urgent Care PLLC

  dba Urgent Team

  • Family Medicine Physician
  • Murfreesboro, TN
  • NPI 1366644361
  Medicare reassignment NPD
• The Little Clinic of Tennessee LLC

  • Family Nurse Practitioner
  • White House, TN
  • NPI 1487848800
  Medicare reassignment NPD
• Kiosk Medicine Kentucky LLC

  • Family Nurse Practitioner
  • Louisville, KY
  • NPI 1205885035
  Medicare reassignment NPD
• Primary Health Care Center of Dade, Inc.

  dba Primary Health Care Center

  • Federally Qualified Health Center (FQHC)
  • Fort Oglethorpe, GA
  • NPI 1255512182
  Medicare reassignment NPD
• The Little Clinic of Arizona LLC

  • Family Nurse Practitioner
  • Buckeye, AZ
  • NPI 1023216249
  Medicare reassignment NPD
• Crossroads Urgent Care PLLC

  dba Urgent Team

  • Rural Health Clinic/Center
  • South Pittsburg, TN
  • NPI 1427781129

  Family Medicine

  NPD
• Little Clinic of Mississippi LLC

  • Family Nurse Practitioner
  • Olive Branch, MS
  • NPI 1740699271
  NPD
• Primary Health Care Center of Dade, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ringgold, GA
  • NPI 1326714569
  NPD
• Primary Health Care Center of Dade, Inc.

  dba College and Career Academy, SBHC

  • Federally Qualified Health Center (FQHC)
  • Ringgold, GA
  • NPI 1699503771
  NPD
• TLC of Georgia LLC

  dba The Little Clinic

  • Family Nurse Practitioner
  • Jefferson, GA
  • NPI 1750677241
  NPD

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1366480014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2485 BASKETTE WAY",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374217615",
            "telephone_number": "423-240-4829",
            "fax_number": "615-425-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 MCBRIEN RD",
            "city": "EAST RIDGE",
            "state": "TN",
            "postal_code": "374123223",
            "telephone_number": "423-875-0700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2009 Old Lafayette Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Oglethorpe",
            "state": "GA",
            "postal_code": "307423510",
            "country_code": "US",
            "telephone_number": "706-866-5520",
            "fax_number": "706-657-2958",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATRIC",
        "first_name": "KENNETH",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "69243",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD0000027485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruth A Nielson, DC
• Nathaniel Graham Norman, PHARMD
• Kurtisha Norris
• Jancy Allison Parkerson, DMD
• Kalpeshkumar Rameshbhai Patel, PHARMACIST
• Bruce Allen Pendley, MD
• Carlina Lopez Pendon, FNP-C
• Tessa K Poteralski, PT
• Puckett Emergency Medical Services, LLC (Puckett Emergency Medical Services)
• Puckett Med Van LLC

• Family Medicine Physician in East Ridge, TN
• Providers in East Ridge, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 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.

Verify at the official NPI Registry.