NPIMap

Individual provider Active NPI

Daniel D Carroll, MD

  • Family Medicine Physician
  • Kingsport, TN
National Provider Identifier
1467428987
Registry record updated Nov 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19714 Issued in TN
Practice address
2202 N John B Dennis Hwy Ste 204
Kingsport, TN 37660-5904
Phone
(423) 224-3300
Fax
(423) 378-5324
NPI assigned
Feb 24, 2006
Last updated
Nov 1, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101047148 VA
Family Medicine Physician 207Q00000X 19714 TN Primary

Addresses

Primary practice location

2202 N John B Dennis Hwy Ste 204
Kingsport, TN 37660-5904

Mailing address

105 W Stone Dr
Suite 6a
Kingsport, TN 37660-3365
Phone (423) 408-7220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100506000657 TN Practitioner - Family Practice 5597848614 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
East Tennessee State University Quillen College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holston Medical Group PCGroup PAC ID 8224935754, 239 clinicians

Practice addresses (Care Compare)

105 W Stone Dr
Suite 3a
Kingsport, TN 37660-3256
Phone (423) 392-6200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19714TNMDFamily Medicine Physician
0101047148VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmont Medical Associates Inc Family Medicine CurrentSince Jul 1, 2012 Accepting new patients
Holston Medical Group PC Family Medicine CurrentSince May 11, 2022 Accepting new patients
Holston Medical Group, PC PastSince May 11, 2022 Accepting new patients

Locations

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

350 Steeles Rd
#1
Bristol, TN 37620
Phone (423) 844-4925

105 W Park Dr
Kingsport, TN 37660
Phone (423) 224-3220

105 W Stone Dr
Ste 3A
Kingsport, TN 37660
Phone (423) 323-6200

105 W Stone Dr
Ste 6A
Kingsport, TN 37660
Phone (423) 408-7220

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

851 Locust St
Rogersville, TN 37857
Phone (423) 272-2671

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

Interoperability endpoints

  • FHIR API: https://fhir.holstonmedicalgroup.com/R4/open-R4
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541030400000",
    "number": "1467428987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W STONE DR",
            "address_2": "SUITE 6A",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603365",
            "telephone_number": "423-408-7220",
            "fax_number": "423-408-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 N JOHN B DENNIS HWY STE 204",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376605904",
            "telephone_number": "423-224-3300",
            "fax_number": "423-378-5324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "DANIEL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2018-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101047148",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "19714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.