Newport Pediatrics, P.C.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

NEWPORT PEDIATRICS, P.C.

Practice address

1829 Crowe LN
Newport, TN 37821-7264

Phone

(423) 623-0653

Fax

(423) 625-8264

NPI assigned

Apr 17, 2007

Last updated

Mar 1, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Samuel Mack Puckett, M.D.NPI 1770501819

Title

President

Phone

(423) 623-0653

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467678706. Details of each certification follow.

• CCN 888943 Rural health clinic · Active · Details

Rural health clinic certification: CCN 888943

Legal name

NEWPORT PEDIATRICS, P.C.

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Aug 12, 2025

Last certification

Aug 12, 2025

Ownership / control type

1B

Organization structure

CorporationProprietary

Enrollment address

1829 Crowe LN
Newport, TN 37821-7264

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Samuel Mack Puckett, M.D.

  • Pediatrics Physician
  • Newport, TN
  • NPI 1770501819

  5% Or Greater Direct Ownership Interest

  CMS ownership

Practitioners 8

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.

• Courtney Vance Burgin, FNP-BC

  • Family Nurse Practitioner
  • Newport, TN
  • NPI 1912568494
  Medicare reassignment NPD
• Darla Kay Morgan, APN

  • Nurse Practitioner
  • Greeneville, TN
  • NPI 1902050164
  Medicare reassignment NPD
• Jennifer Lea Sauceman, M.D.

  • Pediatrics Physician
  • Newport, TN
  • NPI 1992930846
  Medicare reassignment NPD
• Bettina N Shelton, FNP-BC

  • Family Nurse Practitioner
  • Johnson City, TN
  • NPI 1073175386
  Medicare reassignment NPD
• Samuel Mack Puckett, M.D.

  • Pediatrics Physician
  • Newport, TN
  • NPI 1770501819
  Authorized official Same address or phone
• Esther M Hooper-Layman, C.P.N.P.

  • Pediatric Nurse Practitioner
  • Newport, TN
  • NPI 1548288699
  NPD
• Jill McDowell Newsome, M.D.

  • Pediatrics Physician
  • Seymour, TN
  • NPI 1437161098
  NPD (past)
• Laura Brawley Strader, C.F.N.P.

  • Family Nurse Practitioner
  • Newport, TN
  • NPI 1750315099
  NPD (past)

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740787200000",
    "number": "1467678706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1829 CROWE LN",
            "city": "NEWPORT",
            "state": "TN",
            "postal_code": "378217264",
            "telephone_number": "423-623-0653",
            "fax_number": "423-625-8264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1829 CROWE LN",
            "city": "NEWPORT",
            "state": "TN",
            "postal_code": "378217264",
            "telephone_number": "423-623-0653",
            "fax_number": "423-625-8264"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 College St",
            "address_purpose": "LOCATION",
            "city": "Newport",
            "state": "TN",
            "postal_code": "378213619",
            "country_code": "US",
            "telephone_number": "423-623-0653",
            "fax_number": "423-625-8264",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NEWPORT PEDIATRICS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2025-03-01",
        "certification_date": "2025-03-01",
        "status": "A",
        "authorized_official_last_name": "PUCKETT",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "MACK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-623-0653",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3710281",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Newport Drug Store, Inc. (Newport Drugs)
• Newport Family Dental Care PLLC
• Newport Family Eyecare (Tarr Family Eyecare)
• Newport Internal Medicine, PC
• Newport Interventional Pain Management
• Newport TN Opco LLC
• Jacob Norris, O.D.
• Kenneth Chad Norton, PTA
• Khaled Kamal Nour, M.D.
• Katherine Orem, LPC-MHSP

• Pediatrics Physician in Newport, TN
• Providers in Newport, TN by specialty
• Pediatrics Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.

Verify at the official NPI Registry.