Individual provider Active NPI

Lauren Rene Panezich, M.D.

  • Family Medicine Physician
  • Clinton, TN
National Provider Identifier
1396288650
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
59405 Issued in TN
Practice address
102 S Charles G Seivers Blvd
Clinton, TN 37716-3916
Phone
(865) 457-4702
Fax
(865) 374-2115
NPI assigned
Nov 18, 2016
Last updated
Jan 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD.36850 AL
Family Medicine Physician 207Q00000X L.4372R AL
Family Medicine Physician 207Q00000X 59405 TN Primary

Addresses

Primary practice location

102 S Charles G Seivers Blvd
Clinton, TN 37716-3916

Mailing address

102 S Charles G Seivers Blvd
Clinton, TN 37716-3916
Phone (865) 457-4702

Other identifiers 1

IdentifierTypeStateIssuer
Q049891MedicaidTN

Other names 1

  • Dr. Lauren Rene Smith Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Smith.Lauren@covenanthealth.cernerdirect.com

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
I20190808000690 TN Practitioner - Family Practice 2961739396 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Alabama School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical Group IncGroup PAC ID 2860305463, 363 clinicians

Practice addresses (Care Compare)

110 Industrial Park LN
Lake City, TN 37769-2300
Phone (865) 426-7441

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L.4372RALMDFamily Medicine Physician
MD.36850ALMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group, Inc. Family Medicine CurrentSince Aug 1, 2019 Accepting new patients
Covenant Medical Group, Inc CurrentSince Aug 1, 2019 Accepting new patients

Locations

102 S Seivers Blvd
Clinton, TN 37716
Phone (865) 457-4702

Dept 888179
Knoxville, TN 37995

111 Clyde St
Loudon, TN 37774
Phone (865) 458-1554

110 Industrial Park Ln
Rocky Top, TN 37769
Phone (865) 426-7421

Interoperability endpoints

  • Direct secure messaging: smith.lauren@covenanthealth.cernerdirect.com

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1479427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1396288650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 S CHARLES G SEIVERS BLVD",
            "city": "CLINTON",
            "state": "TN",
            "postal_code": "377163916",
            "telephone_number": "865-457-4702",
            "fax_number": "865-374-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 S CHARLES G SEIVERS BLVD",
            "city": "CLINTON",
            "state": "TN",
            "postal_code": "377163916",
            "telephone_number": "865-457-4702",
            "fax_number": "865-374-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANEZICH",
        "first_name": "LAUREN",
        "middle_name": "RENE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-18",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "MD.36850",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "L.4372R",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "59405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q049891",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Smith.Lauren@covenanthealth.cernerdirect.com",
            "affiliation": "N",
            "address_1": "110 Executive Park Dr",
            "city": "Clinton",
            "state": "TN",
            "country_code": "US",
            "postal_code": "37716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LAUREN",
            "last_name": "SMITH",
            "middle_name": "RENE",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Clinton, TN

Sources for this page

Verify at the official NPI Registry.