Individual provider Active NPI

Paul Andrew Lee, PA

  • Physician Assistant
  • Kingsport, TN
National Provider Identifier
1447279856
Registry record updated Feb 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
424 Issued in TN
Practice address
2205 Pavilion Dr
Suite 201
Kingsport, TN 37660-4641
Phone
(423) 857-7650
Fax
(423) 857-7655
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 424 TN Primary
Physician Assistant 363A00000X 0110840851 VA

Addresses

Primary practice location

2205 Pavilion Dr
Suite 201
Kingsport, TN 37660-4641

Mailing address

2205 Pavilion Dr
Suite 201
Kingsport, TN 37660-4641
Phone (423) 857-7650

Other identifiers 5

IdentifierTypeStateIssuer
1511020MedicaidTN
P00698768OtherTNRAILROAD MEDICARE
8923655MedicaidVA
Q003286MedicaidTN
1447279856MedicaidVA

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080103000714 TN Practitioner - Physician Assistant 7416037361 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellmont Cardiology ServicesGroup PAC ID 5799970281, 137 clinicians

Practice addresses (Care Compare)

130 W Ravine Rd
Kingsport, TN 37660-3831
Phone (423) 244-4000

2000 Brookside Dr
Kingsport, TN 37660-4627
Phone (423) 320-5000

2033 Meadowview LN
Kingsport, TN 37660-7569
Phone (423) 230-5000

2050 Meadowview Pkwy
Kingsport, TN 37660-7475
Phone (423) 230-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmont Medical Associates, Inc. CurrentSince Jan 19, 2020 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Jan 19, 2020 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Jan 19, 2020 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Dec 17, 2007 Accepting new patients

Locations

438 E Vann Rd
Ste 202
Greeneville, TN 37743
Phone (423) 278-1703

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

2205 Pavilion Dr
Ste 201
Kingsport, TN 37660
Phone (423) 224-2370

391 Falls Dr NW
Abingdon, VA 24210
Phone (276) 628-4406

16000 Johnston Memorial Dr
Ste 212
Abingdon, VA 24211
Phone (276) 258-2732

1990 Holton Ave E
Big Stone Gap, VA 24219
Phone (276) 523-3111

127 Health Care Dr
Ste 3
Pennington Gap, VA 24277
Phone (276) 299-5000

Organizations & group practices 7

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.

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": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487116800000",
    "number": "1447279856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 PAVILION DR",
            "address_2": "SUITE 201",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604641",
            "telephone_number": "423-857-7650",
            "fax_number": "423-857-7655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 PAVILION DR",
            "address_2": "SUITE 201",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604641",
            "telephone_number": "423-857-7650",
            "fax_number": "423-857-7655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "PAUL",
        "middle_name": "ANDREW",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2017-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "424",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110840851",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1511020",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00698768",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8923655",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q003286",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447279856",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.