Individual provider Active NPI

Kelly Butler Patterson, M.D.

  • Emergency Medicine Physician
  • Knoxville, TN
National Provider Identifier
1376589093
Registry record updated May 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD0000034587 Issued in TN
Practice address
2018 W Clinch Ave
Knoxville, TN 37916-2301
Phone
(865) 541-8000
NPI assigned
Jun 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD34587 TN
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X MD34587 TN
Emergency Medicine Physician 207P00000X MD0000034587 TN Primary

Addresses

Primary practice location

2018 W Clinch Ave
Knoxville, TN 37916-2301

Mailing address

7023 Lawford Rd
Knoxville, TN 37919-7459

Other identifiers 3

IdentifierTypeStateIssuer
4079531OtherTNBLUE CROSS
64046832MedicaidKY
5440405MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20230215000206 TN Practitioner - Emergency MedicinePractitioner - Pediatric Medicine 9335511617 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD0000034587TNMDEmergency Medicine Physician
MD34587TNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Emergency Physicians LLC Emergency Medicine CurrentSince Nov 8, 2022 Accepting new patients

Locations

2018 Clinch Ave
Knoxville, TN 37916
Phone (865) 541-8000

9352 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-1000

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431216000000",
    "number": "1376589093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7023 LAWFORD RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379197459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2018 W CLINCH AVE",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379162301",
            "telephone_number": "865-541-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATTERSON",
        "first_name": "KELLY",
        "middle_name": "BUTLER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2015-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "MD34587",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "TN",
            "license": "MD34587",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "MD0000034587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4079531",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64046832",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5440405",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.