Active NPI
Bennie W Whitehead, MD
- Emergency Medicine Physician
- Harriman, TN
National Provider Identifier
1437180908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 018427
- Practice address
- 412 Devonia St
Harriman, TN 37748-2009 - Phone
- (865) 882-1323
- Fax
- (865) 291-3228
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 018427 | TN | Primary |
Addresses
Primary practice location
412 Devonia St
Harriman, TN 37748-2009
Mailing address
PO Box 636019
Cincinnati, OH 45263-6019
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000361799 | Other | KY | ANTHEM BCBS OF KY |
| 3065071 | Medicaid | TN | |
| 3058965 | Other | TN | BCBS OF TENNESSEE |
| P00255557 | Other | TN | RAILROAD MEDICARE |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 018427 | TN | MD | Emergency Medicine Physician |
| 18427 | TN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Afc Urgent Care and Family Care of WNC, PLLC | Past | Accepting new patients |
Interoperability endpoints
- bwhiteh1@yourcarecommunity.org
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.
-
- Urgent Care Clinic/Center
- Charlotte, NC
- NPI 1679066658
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195430400000",
"number": "1437180908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 636019",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452636019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 DEVONIA ST",
"city": "HARRIMAN",
"state": "TN",
"postal_code": "377482009",
"telephone_number": "865-882-1323",
"fax_number": "865-291-3228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITEHEAD",
"first_name": "BENNIE",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-05",
"last_updated": "2007-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "TN",
"license": "018427",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS OF KY",
"identifier": "000000361799",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3065071",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF TENNESSEE",
"identifier": "3058965",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00255557",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harriman, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.