Gregg H.D. Kesterson, MD

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

17126 Issued in TN

Practice address

105 Broyles Dr
Suite B
Johnson City, TN 37601-2542

Phone

(423) 722-4000

Fax

(423) 722-4004

NPI assigned

Jun 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2017 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MCC, Inc.

  • Family Medicine Physician
  • Johnson City, TN
  • NPI 1003935321
  NPD (past)
• Summit Medical Group, PLLC

  • Internal Medicine Physician
  • Brentwood, TN
  • NPI 1659090298
  NPD (past)
• Summit Medical Group, PLLC

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1699722470

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479513600000",
    "number": "1376585919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7731 CHEROKEE SPRINGS WAY",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379199030",
            "telephone_number": "865-470-2468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 BROYLES DR",
            "address_2": "SUITE B",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012542",
            "telephone_number": "423-722-4000",
            "fax_number": "423-722-4004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESTERSON",
        "first_name": "GREGG",
        "middle_name": "H.D.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-11",
        "last_updated": "2016-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "17126",
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "TN",
            "license": "17126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "110098564",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3019399",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Ryan Kenney
• Martha M. Kennon, PH.D.
• Linda Elrod Kerley, RPH
• Linda J Kerley, FNP
• Audrey Kessler, RD
• Brandie Ketron, PHARMD
• Brandon D Ketron, DO
• Ginger Y Ketron, LCSW
• Molly Marie Ketron, PHARMD
• Maxwell Key

• Addiction Medicine (Internal Medicine) Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Addiction Medicine (Internal Medicine) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.