Active NPI
Charlie Grooms, FNP-BC
- Nurse Practitioner
- Newport, TN
National Provider Identifier
1568879823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 18789
- Practice address
- 222 Heritage Blvd
Newport, TN 37821-4200 - Phone
- (423) 581-8140
- Fax
- (423) 581-8131
- NPI assigned
- Jul 18, 2014
- Last updated
- Feb 21, 2018
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 18789 | TN | Primary |
Addresses
Primary practice location
222 Heritage Blvd
Newport, TN 37821-4200
Mailing address
P.O. Box 754
Smoky MTN. Home Health and Hospice
Newport, TN 37822-0754
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: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151210000827 | TN | Order and Referring Only - Nurse Practitioner | 8921309220 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18789 | TN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519171200000",
"number": "1568879823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 754",
"address_2": "SMOKY MTN. HOME HEALTH AND HOSPICE",
"city": "NEWPORT",
"state": "TN",
"postal_code": "378220754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 HERITAGE BLVD",
"city": "NEWPORT",
"state": "TN",
"postal_code": "378214200",
"telephone_number": "423-581-8140",
"fax_number": "423-581-8131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROOMS",
"first_name": "CHARLIE",
"credential": "FNP-BC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-18",
"last_updated": "2018-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "TN",
"license": "18789",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newport, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2018; 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.