NPIMap

Individual provider Active NPI

Michelle Lee Davenport, M.D.

  • Internal Medicine Physician
  • Elizabethton, TN
National Provider Identifier
1497813026
Registry record updated Jan 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
36009 Issued in TN
Practice address
306 Pine Hill Rd
Elizabethton, TN 37643-2920
Phone
(423) 542-4189
Fax
(423) 542-4181
NPI assigned
Dec 5, 2006
Last updated
Jan 14, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 36009 TN Primary
Pediatrics Physician 208000000X 36009 TN

Addresses

Primary practice location

306 Pine Hill Rd
Elizabethton, TN 37643-2920

Mailing address

306 Pine Hill Rd
Elizabethton, TN 37643-2920
Phone (423) 542-4189

Other identifiers 1

IdentifierTypeStateIssuer
3379172MedicaidTN

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
I20100419000324 TN Practitioner - Internal MedicinePractitioner - Pediatric Medicine 6103953401 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
James Lee DavenportGroup PAC ID 1951438241, 2 clinicians
Champion Physical Therapy LLC HallsGroup PAC ID 1355416306, shared by 4 NPIs, 277 clinicians

Practice addresses (Care Compare)

306 Pine Hill Rd
Elizabethton, TN 37643-2920
Phone (423) 542-4189

420 Railroad St
Elizabethton, TN 37643-2504
Phone (423) 297-1813

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Organizations & group practices 1

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 6

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": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263427200000",
    "number": "1497813026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 PINE HILL RD",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432920",
            "telephone_number": "423-542-4189",
            "fax_number": "423-542-4181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 PINE HILL RD",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432920",
            "telephone_number": "423-542-4189",
            "fax_number": "423-542-4181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "MICHELLE",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2010-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "36009",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "36009",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3379172",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethton, TN

Sources for this page

Verify at the official NPI Registry.