NPIMap

Organization Active NPI

Faculty Internal Medicine PLLC

  • Specialist
  • Knoxville, TN
National Provider Identifier
1417095308
Registry record updated Oct 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
FACULTY INTERNAL MEDICINE PLLC
Practice address
11440 Parkside Dr
Suite 302
Knoxville, TN 37934-2658
Phone
(865) 218-9220
Fax
(865) 218-3332
NPI assigned
Feb 2, 2007
Last updated
Oct 1, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2014

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

Authorized official

Name
Crystal Dawn Lester
Title
Billing Manager
Phone
(865) 288-1548

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

11440 Parkside Dr
Suite 302
Knoxville, TN 37934-2658

Mailing address

11440 Parkside Dr
Suite 302
Knoxville, TN 37934-2658
Phone (865) 544-9740

Other identifiers 1

IdentifierTypeStateIssuer
3623639MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031222000008 TN Part B Supplier - Clinic/Group Practice 4789582305 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
Practice locations: Knoxville, TN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Faculty Internal Medicine3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412121600000",
    "number": "1417095308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11440 PARKSIDE DR",
            "address_2": "SUITE 302",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379342658",
            "telephone_number": "865-544-9740",
            "fax_number": "865-377-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11440 PARKSIDE DR",
            "address_2": "SUITE 302",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379342658",
            "telephone_number": "865-218-9220",
            "fax_number": "865-218-3332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACULTY INTERNAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2014-10-01",
        "status": "A",
        "authorized_official_last_name": "LESTER",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "865-288-1548"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3623639",
            "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 Oct 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.