Active NPI
Kelly Butler Patterson, M.D.
- Emergency Medicine Physician
- Knoxville, TN
National Provider Identifier
1376589093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- MD0000034587
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4079531 | Other | TN | BLUE CROSS |
| 64046832 | Medicaid | KY | |
| 5440405 | Medicaid | TN |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD0000034587 | TN | MD | Emergency Medicine Physician |
| MD34587 | TN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Emergency Physicians LLC | Emergency Medicine | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2015; 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.