Carlos Alexander Anderson
Individual provider Active NPI Nurse Practitioner · Sevierville, TN
NPI 1578055836 · NPPES record last updated Jun 3, 2018
Key facts
- NPI
- 1578055836
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 24112 (TN)
- Practice address
- 312 Prince St
Sevierville, TN 37862-3823 - Phone
- (865) 744-7684
- NPI assigned
- Jun 3, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Endocrinology Consultants of East TN
Practice addresses (Care Compare)
414 Greenbelt Dr
Maryville, TN 37804-5702
Phone (865) 637-8812
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230915003197 | TN | Practitioner - Nurse Practitioner | 1951653088 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 210522 | TN | MD | Registered Nurse |
| 24112 | TN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Endocrinology Consultants of East TN | Current |
Accepting new patients | |
| Blount Memorial Physician Group, Inc | Past | Accepting new patients |
Locations
122 Kent Pl
Alcoa, TN 37701
Phone (865) 238-6630
1450 Dowell Springs Blvd
Ste 300
Knoxville, TN 37909
Phone (865) 470-9820
414 Greenbelt Dr
Maryville, TN 37804
Phone (865) 637-8812
Interoperability endpoints
- https://api.platform.athenahealth.com/15627/brand/1/csg/1/fhir/r4
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 210522 | TN | |
| Nurse Practitioner | 363L00000X | 24112 | TN | Yes |
Addresses
Primary practice location
312 Prince St
Sevierville, TN 37862-3823
Mailing address
10546 Arnold Lane
Mascot, TN 37806
Phone (865) 304-6774
Other providers in Sevierville, TN
- Allergy Associates PA
- Christina M Alston
- Rosa Elena Amaya Molina
- Marvin Charles Amos
- Barry D Anderson
- Siriprawn Jerrie Anderson
- Apogee Anesthesia Consultants LLC
- Cody Armstrong
- Elizabeth June Arnold
- Harlon Arnold
All providers in Sevierville, TN · Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.