Individual provider Active NPI

Eric R Jensen, MD

  • Pediatric Surgery Physician
  • Knoxville, TN
National Provider Identifier
1407883986
Registry record updated Feb 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
MD41046 Issued in TN
Practice address
2100 Clinch Ave Ste 510
Knoxville, TN 37916-2225
Phone
(865) 541-2131
Fax
(877) 821-0891
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X MD41046 TN Primary

Addresses

Primary practice location

2100 Clinch Ave Ste 510
Knoxville, TN 37916-2225

Mailing address

PO Box 15004
Knoxville, TN 37901-5004
Phone (865) 541-8895

Other practice location 1

1817 W Morris Blvd
Morristown, TN 37813-2837
Phone (865) 546-2131

Other practice location 2

502 Winfield Dunn Pkwy
Sevierville, TN 37876-5509
Phone (865) 546-2131

Other practice location 3

1025 Childrens Way
Knoxville, TN 37922-7713
Phone (865) 546-2131

Other practice location 4

207 E Emory Rd
Powell, TN 37849-4047
Phone (865) 546-2131

Other identifiers 1

IdentifierTypeStateIssuer
3062658MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD41046TNMDPediatric Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Tennessee Children'S Hospital Association, Inc. Past Accepting new patients
East Tennessee Children'S Hospital Association, Inc. Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739491200000",
    "number": "1407883986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15004",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379015004",
            "telephone_number": "865-541-8895",
            "fax_number": "865-633-4808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 CLINCH AVE STE 510",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379162225",
            "telephone_number": "865-541-2131",
            "fax_number": "877-821-0891"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1817 W Morris Blvd",
            "address_purpose": "LOCATION",
            "city": "Morristown",
            "state": "TN",
            "postal_code": "378132837",
            "country_code": "US",
            "telephone_number": "865-546-2131",
            "fax_number": "877-821-0891",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "502 Winfield Dunn Pkwy",
            "address_purpose": "LOCATION",
            "city": "Sevierville",
            "state": "TN",
            "postal_code": "378765509",
            "country_code": "US",
            "telephone_number": "865-546-2131",
            "fax_number": "877-821-0891",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1025 Childrens Way",
            "address_purpose": "LOCATION",
            "city": "Knoxville",
            "state": "TN",
            "postal_code": "379227713",
            "country_code": "US",
            "telephone_number": "865-546-2131",
            "fax_number": "877-821-0891",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "207 E Emory Rd",
            "address_purpose": "LOCATION",
            "city": "Powell",
            "state": "TN",
            "postal_code": "378494047",
            "country_code": "US",
            "telephone_number": "865-546-2131",
            "fax_number": "877-821-0891",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "ERIC",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "TN",
            "license": "MD41046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3062658",
            "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 Feb 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.