Terry Lee Puckett, M.D., M.P.H.

Primary specialty

Aerospace Medicine PhysicianTaxonomy code 2083A0100X

License

0101241208 Issued in VA

Practice address

24530 Falcon Place Blvd Ste 100
Abingdon, VA 24211-7665

Phone

(276) 619-0075

Fax

(276) 619-0077

NPI assigned

Feb 28, 2006

Last updated

Jun 5, 2018By 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 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TN, VA2 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 2

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.

• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Cardiovascular Disease Physician
  • Marion, VA
  • NPI 1326159567
  Medicare reassignment NPD
• Wellmont Medical Associates Inc

  dba Ballad Health Medical Associates

  • Pulmonary Disease Physician
  • Bristol, TN
  • NPI 1780986257
  Medicare reassignment NPD
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Internal Medicine Physician
  • Marion, VA
  • NPI 1124438627
  NPD
• Blue Ridge Medical Management Corporation

  dba First Assist Urgent Care

  • Urgent Care Clinic/Center
  • Elizabethton, TN
  • NPI 1144380833
  NPD
• Sacred Heart Health System, Inc.

  dba Ascension Medical Group Sacred Heart Urgent Care

  • Urgent Care Clinic/Center
  • Pensacola, FL
  • NPI 1770533077
  NPD (past)
• Tri Hospital MRI Center

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Port Huron, MI
  • NPI 1063581353
  NPD (past)
• Wellmont Medical Associates, Inc.

  dba Ballad Health Medical Associates

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1154789030
  NPD (past)

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528156800000",
    "number": "1376510222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 CAMPUS DR",
            "address_2": "SUITE 100",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242109700",
            "telephone_number": "276-739-8010",
            "fax_number": "276-628-1410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24530 FALCON PLACE BLVD STE 100",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242117665",
            "telephone_number": "276-619-0075",
            "fax_number": "276-619-0077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 W Stone Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376606027",
            "country_code": "US",
            "telephone_number": "423-224-3701",
            "fax_number": "423-224-3709",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "378 Marketplace Dr Ste 5",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376042361",
            "country_code": "US",
            "telephone_number": "423-282-0751",
            "fax_number": "423-282-1577",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "603 Campus Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Abingdon",
            "state": "VA",
            "postal_code": "242109700",
            "country_code": "US",
            "telephone_number": "276-739-8010",
            "fax_number": "276-628-1410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "TERRY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D., M.P.H.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2018-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "TN",
            "license": "MD 18289",
            "primary": false
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "VA",
            "license": "0101241208",
            "primary": true
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "TN",
            "license": "MD 18289",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q000141",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376510222",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01599940",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Ellen Pritchard-Compton, MSW, MED
• Kaylyn Riley Proctor, LCSW
• Ashley Renae Pruitt, COTA/L
• Psych Services PC (Elvera E. McLees, Ph.D.)
• Gloria Jean Puckett, COTA/L
• Laith Osama Ahmad Qasarweh, M.D.
• Rabia Qutubuddin, PA-C
• Kayla Marie Ramplin, DDS
• Ralph Darrell Ramsden, PHD
• Breanna Michelle Rasnake, PNP-PC

• Aerospace Medicine Physician in Abingdon, VA
• Providers in Abingdon, VA by specialty
• Aerospace Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; 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.