Active NPI
Kevin Scott Preston, MD
- Diagnostic Radiology Physician
- Clarksville, TN
National Provider Identifier
1437313202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 51131
- Practice address
- 490 Dunlop LN
Clarksville, TN 37040-5007 - Phone
- (931) 245-8622
- Fax
- (931) 245-8663
- NPI assigned
- Jul 10, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 11014044A | IN | |
| Diagnostic Radiology Physician | 2085R0202X | 51131 | TN | Primary |
Addresses
Primary practice location
490 Dunlop LN
Clarksville, TN 37040-5007
Mailing address
PO Box 3799
Clarksville, TN 37043-3799
Phone (931) 245-7000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q014444 | Medicaid | TN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kevin.preston.1@8042.direct.athenahealth.com | Direct | Premier Medical Group PC |
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
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- University of Louisville School of Medicine, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
490 Dunlop LN
Clarksville, TN 37040-5007
Phone (931) 245-7000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51131 | TN | MD | Diagnostic Radiology Physician |
| 11014044A | IN | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Medical Group PC | Current | Accepting new patients |
Locations
1832 Memorial Dr
Clarksville, TN 37043
Phone (931) 645-3552
Interoperability endpoints
- kevin.preston.1@8042.direct.athenahealth.com
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.
-
- General Practice Physician
- Clarksville, TN
- NPI 1740242957
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637280000000",
"number": "1437313202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3799",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370433799",
"telephone_number": "931-245-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "490 DUNLOP LN",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370405007",
"telephone_number": "931-245-8622",
"fax_number": "931-245-8663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRESTON",
"first_name": "KEVIN",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-10",
"last_updated": "2021-11-19",
"certification_date": "2021-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "IN",
"license": "11014044A",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "TN",
"license": "51131",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Q014444",
"state": "TN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kevin.preston.1@8042.direct.athenahealth.com",
"affiliation": "Y",
"affiliationName": "Premier Medical Group PC",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "490 Dunlop Ln",
"city": "Clarksville",
"state": "TN",
"country_code": "US",
"postal_code": "370405007",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2021; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.