Individual provider Active NPI

Fernando A Zepeda, M.D.

  • Anesthesiology Physician
  • Johnson City, TN
National Provider Identifier
1477553303
Registry record updated Jul 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD0000029134 Issued in TN
Practice address
1009 Novus Dr Ste 2
Johnson City, TN 37604-8237
Phone
(423) 283-0776
Fax
(423) 968-5697
NPI assigned
Jul 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD0000029134 TN Primary

Addresses

Primary practice location

1009 Novus Dr Ste 2
Johnson City, TN 37604-8237

Mailing address

1009 Novus Dr Ste 2
Johnson City, TN 37604-8237
Phone (423) 283-0776

Other identifiers 1

IdentifierTypeStateIssuer
3868388MedicaidTN

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101220000115 TN Practitioner - Anesthesiology 8628266517 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Mayo Medical School, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Paragon Anesthesia PCGroup PAC ID 8921044744, 214 clinicians

Practice addresses (Care Compare)

1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 390-0451

1501 W Elk Ave
Elizabethton, TN 37643-2874
Phone (423) 390-0451

300 Med Tech Pkwy
Johnson City, TN 37604-2277
Phone (423) 390-0451

400 N State of Franklin Rd
Johnson City, TN 37604-6035
Phone (423) 390-0451

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD0000029134TNMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Paragon Anesthesia PC Anesthesiology CurrentSince Jul 22, 2022 Accepting new patients
East Tennessee Ambulatory Surgery Center LLC CurrentSince Jul 22, 2022 Accepting new patients
Singing River Health System Past Accepting new patients

Locations

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

320 Bristol West Blvd
Ste 1A
Bristol, TN 37620
Phone (423) 758-1030

1501 W Elk Ave
Elizabethton, TN 37643
Phone (423) 542-1300

400 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-1310

2000 Brookside Dr
Kingsport, TN 37660
Phone (423) 857-7144

10415 Wallace Alley St
Kingsport, TN 37663
Phone (423) 390-0451

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1477553303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 NOVUS DR STE 2",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376048237",
            "telephone_number": "423-283-0776",
            "fax_number": "423-968-5697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 NOVUS DR STE 2",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376048237",
            "telephone_number": "423-283-0776",
            "fax_number": "423-968-5697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZEPEDA",
        "first_name": "FERNANDO",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "MD0000029134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3868388",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.