Individual provider Active NPI

Kenneth Michael Homolya Jr., M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Brentwood, TN
National Provider Identifier
1548302789
Registry record updated Oct 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
45952 Issued in TN
Practice address
330 Franklin Rd
Suite 135a #295
Brentwood, TN 37027-3280
Phone
(615) 431-5484
Fax
(615) 447-5959
NPI assigned
Feb 13, 2007
Last updated
Oct 19, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 19, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X 45952 TN Primary

Addresses

Primary practice location

330 Franklin Rd
Suite 135a #295
Brentwood, TN 37027-3280

Mailing address

625 Johnny Cash Blvd
Ste 3
Hendersonville, TN 37075-2602
Phone (615) 431-5484

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
I20100908000846 TN Practitioner - Pain ManagementPractitioner - Anesthesiology 9931254828 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Anesthesiology
Education
University of Toledo College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ken Homolya MD LLCGroup PAC ID 5799960464, 12 clinicians

Practice addresses (Care Compare)

625 E Main St
Suite 3
Hendersonville, TN 37075-2602
Phone (615) 431-5484

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ken Homolya, MD, LLC Pain Medicine CurrentSince Apr 15, 2011 Accepting new patients
Ken Homolya MD LLC CurrentSince May 1, 2011 Accepting new patients
Dunn Clinic Past Accepting new patients
University Anesthesiology Associates PSC Pain Medicine Past Accepting new patients

Locations

406 N Whitney Ave
Ste 2
Cookeville, TN 38501
Phone (931) 372-1799

545 E Spring St
Cookeville, TN 38501
Phone (931) 372-1799

929 W Jackson St
Ste A
Cookeville, TN 38501
Phone (931) 372-1799

103 Hazel Path
Ste 7
Hendersonville, TN 37075
Phone (615) 431-5484

625 Johnny Cash Blvd
Ste 3
Hendersonvlle, TN 37075
Phone (615) 431-5484

5114 Old Hickory Blvd
Ste 201
Hermitage, TN 37076
Phone (615) 431-5484

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1548302789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 JOHNNY CASH BLVD",
            "address_2": "STE 3",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370752602",
            "telephone_number": "615-431-5484",
            "fax_number": "615-447-5959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 FRANKLIN RD",
            "address_2": "SUITE 135A #295",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370273280",
            "telephone_number": "615-431-5484",
            "fax_number": "615-447-5959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOMOLYA",
        "first_name": "KENNETH",
        "middle_name": "MICHAEL",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "TN",
            "license": "45952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brentwood, TN

Sources for this page

Verify at the official NPI Registry.