Active NPI
Robert Miles Kelso, D.D.S.
- General Practice Dentistry
- Knoxville, TN
National Provider Identifier
1487787172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8033
- Practice address
- 6231 Highland Place Way Ste 202
Knoxville, TN 37919-4083 - Phone
- (865) 588-6534
- Fax
- (865) 588-2576
- NPI assigned
- Mar 13, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8033 | TN | Primary |
Addresses
Primary practice location
6231 Highland Place Way Ste 202
Knoxville, TN 37919-4083
Mailing address
6231 Highland Place Way Ste 202
Knoxville, TN 37919-4083
Phone (865) 588-6534
Other practice location 1
6311 Kingston Pike
Suite 3E
Knoxville, TN 37919-4906
Phone (865) 588-6534
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 450517441 | Other | TN | FEDERAL TAX ID |
| 4062119 | Other | TN | BLUE CROSS BLUE SHIELD TN |
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160401001777 | TN | Order and Referring Only - Oral Surgery | 9032416284 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650412800000",
"number": "1487787172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6231 HIGHLAND PLACE WAY STE 202",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379194083",
"telephone_number": "865-588-6534",
"fax_number": "865-588-2576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6231 HIGHLAND PLACE WAY STE 202",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379194083",
"telephone_number": "865-588-6534",
"fax_number": "865-588-2576"
}
],
"practiceLocations": [
{
"address_1": "6311 Kingston Pike",
"address_2": "Suite 3E",
"address_purpose": "LOCATION",
"city": "Knoxville",
"state": "TN",
"postal_code": "379194906",
"country_code": "US",
"telephone_number": "865-588-6534",
"fax_number": "865-588-2576",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KELSO",
"first_name": "ROBERT",
"middle_name": "MILES",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-13",
"last_updated": "2022-04-20",
"certification_date": "2022-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TN",
"license": "8033",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL TAX ID",
"identifier": "450517441",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD TN",
"identifier": "4062119",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.