Kenneth J Reed, P.A.C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA0000000105 Issued in TN

Practice address

131 Hospital LN
Jellico, TN 37762-4404

Phone

(423) 784-7269

Fax

(423) 784-3708

NPI assigned

Oct 12, 2006

Last updated

Jan 18, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kreed@wmg01.gwaydirect.com

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.

• Wynn Habersham Community Clinic Inc

  • Rural Health Clinic/Center
  • La Follette, TN
  • NPI 1417093857
  NPD (past)
• Highland Park Primary Care Center, PLLC

  • Primary Care Clinic/Center
  • Williamsburg, KY
  • NPI 1669617809
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1649369141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 447",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377620447",
            "telephone_number": "423-784-7269",
            "fax_number": "423-784-3708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 HOSPITAL LN",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377624404",
            "telephone_number": "423-784-7269",
            "fax_number": "423-784-3708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REED",
        "first_name": "KENNETH",
        "middle_name": "J",
        "credential": "P.A.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "PA0000000105",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA272",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1522588",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• North Campbell Community Hospital Inc
• North Campbell Community Hospital Inc
• Pine Mountain Emergency Physicians
• Progressive Health of Jellico LLC
• Progressive Health of Jellico LLC
• Sarah Roberts, PHARMD
• Crystal G Smiddy
• Matthew Christopher Sowards, PHARMD, MBA
• Springs of Life
• Walter Stephens, PT

• Medical Physician Assistant in Jellico, TN
• Providers in Jellico, TN by specialty
• Medical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; 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.

Verify at the official NPI Registry.