Kyle W Boren, DO
Individual provider Active NPI Orthopaedic Surgery Physician · Greeneville, TN
NPI 1619256328 · NPPES record last updated Feb 26, 2024
Key facts
- NPI
- 1619256328
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- License
- 3143 (TN)
- Practice address
- 1420 Tusculum Blvd FL 4
Greeneville, TN 37745-4279 - Phone
- (423) 639-2103
- Fax
- (423) 783-5515
- NPI assigned
- Aug 11, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- Lincoln Memorial University Medical Department, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Wellmont Medical Associates Inc
Practice addresses (Care Compare)
1420 Tusculum Blvd
Greeneville, TN 37745-4279
Phone (423) 787-5000
Hospital & facility affiliations
- Amedisys Home Health Care
- Greeneville Community Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hip replacement | 1-10 |
| Knee replacement | 1-10 |
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 1-10 |
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: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170130002605 | TN | Practitioner - Orthopedic Surgery | 8527340322 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3143 | TN | MD | Occupational Therapist |
| 33 | TN | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellmont Medical Associates Inc | Orthopaedic Surgery | Current |
Accepting new patients |
| Wellmont Medical Associates, Inc. | Current |
Accepting new patients | |
| Wellmont Medical Associates Inc | Past |
Accepting new patients | |
| Blue Ridge Medical Management Corporation | Past | Accepting new patients |
Locations
1021 W Oakland Ave
Ste 310
Johnson City, TN 37604
Phone (423) 302-6565
111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 33 | TN | |
| Orthopaedic Surgery Physician | 207X00000X | 3143 | TN | Yes |
Addresses
Primary practice location
1420 Tusculum Blvd FL 4
Greeneville, TN 37745-4279
Mailing address
1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 302-6565
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q025878 | Medicaid | TN |
Other providers in Greeneville, TN
- Blue Ridge Medical Mangement Corporation
- Sylvia D. Boesch-Lewis
- Debbie Ann Bolton
- Johnathan Dallas Boone
- Courtney Larae Boren
- Katie Lynne Styke Boslooper
- Tonya Leeann Bowman
- John Carlton Boys
- Lucy Boys
- Brad and Debbie Phelps Inc
All providers in Greeneville, TN · Orthopaedic Surgery Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2024. 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.