Kellen Thomas Bannon

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

2855 Issued in TN

Practice address

2213 Cherry St
Toledo, OH 43608-2603

Phone

(419) 251-4724

NPI assigned

Jul 10, 2012

Last updated

Oct 25, 2023By 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

Enrolled in TN, AL, KY3 enrollments

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 3

Specialty

Emergency Medicine

Education

West Virginia School of Osteopathic Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeastern Emergency Physicians LLCGroup PAC ID 2466364997, 776 clinicians

Emergency Coverage LLCGroup PAC ID 3072412592, 761 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fort Sanders Regional Medical Center Hospital, Knoxville, TN, CCN 440125
• Morristown Hamblen Hospital Association Hospital, Morristown, TN, CCN 440030
• Starr Regional Medical Center Athens Hospital, Athens, TN, CCN 440068
• Cumberland Medical Center Hospital, Crossville, TN, CCN 440009
• Roane Medical Center Hospital, Harriman, TN, CCN 440031

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kbannon@yourcarecommunity.org

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.

• Emergency Coverage, LLC

  dba Emergency Coverage Corporation of TeamHealth

  • Family Medicine Physician
  • Newport, TN
  • NPI 1427005008

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  Single Specialty, TN

  Medicare reassignment Care Compare group NPD
• App of Tennessee Ed, PLLC

  • Emergency Medicine Physician
  • Maryville, TN
  • NPI 1003230236

  Single Specialty

  Medicare reassignment NPD
• Emergency Services of Mobile PC

  • Emergency Medicine Physician
  • Mobile, AL
  • NPI 1013269802

  Single Specialty

  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Athens Regional Medical Center LLC

  dba Starr Regional Medical Center

  • General Acute Care Hospital
  • Athens, TN
  • NPI 1669567319
  Care Compare affiliation
• Cumberland Medical Center, Inc.

  dba Cumberland Medical Center

  • General Acute Care Hospital
  • Crossville, TN
  • NPI 1871596403
  Care Compare affiliation
• Fort Sanders Regional Medical Center

  • General Acute Care Hospital
  • Knoxville, TN
  • NPI 1942294814
  Care Compare affiliation
• Morristown Hamblen Hospital Association

  dba Morristown Hamblen Healthcare System

  • General Acute Care Hospital
  • Morristown, TN
  • NPI 1912997024
  Care Compare affiliation
• Roane County Medical Center

  dba Covenant Health Roane

  • General Acute Care Hospital
  • Harriman, TN
  • NPI 1700036696
  Care Compare affiliation

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1649535279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 CLINCH AVE",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379162307",
            "telephone_number": "313-674-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2213 CHERRY ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436082603",
            "telephone_number": "419-251-4724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANNON",
        "first_name": "KELLEN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-10",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "2855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649535279",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tina Banks, NURSE ASSISTANT/HOME
• Johnna M Bankston
• Shay Elletha Bankston, LISW
• Jennifer Banner
• Erin Bannon, PH.D.
• Ghada Banoub, RPH
• Nahush Roop Bansal
• Mariah Baptiste
• Theresa M Barabash, C.N.P.
• Mary Ann Barabino

• Emergency Medicine Physician in Toledo, OH
• Providers in Toledo, OH by specialty
• Emergency Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.