Individual provider Active NPI

Saeed Etezadi-Amoli, MD

  • Internal Medicine Physician
  • Knoxville, TN
National Provider Identifier
1669427142
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD15820 Issued in TN
Practice address
6600 Nightingale LN
Knoxville, TN 37909-2754
Phone
(865) 632-5885
Fax
(865) 632-5893
NPI assigned
May 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD15820 TN Primary

Addresses

Primary practice location

6600 Nightingale LN
Knoxville, TN 37909-2754

Mailing address

6600 Nightingale LN
Knoxville, TN 37909-2754
Phone (865) 632-5885

Other identifiers 3

IdentifierTypeStateIssuer
3022975MedicaidTN
4118970OtherTNBLUE CROSS
TN0101OtherTNJOHN DEERE

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060420000533 TN Practitioner - Internal Medicine 5698784551 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD15820TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group, Inc CurrentSince Dec 1, 2012 Accepting new patients
Covenant Medical Group, Inc. Internal Medicine CurrentSince Dec 1, 2012 Accepting new patients
Knoxville Internal Medicine PLLC Internal Medicine Past Accepting new patients
East Tennessee Women'S Care, PC Past Accepting new patients
Health Ventures, Inc Past Accepting new patients

Locations

7564 Mountain Grove Dr
Knoxville, TN 37920
Phone (865) 632-5885

6600 Nightingale Ln
Knoxville, TN 37909
Phone (865) 632-5885

Dept 888179
Knoxville, TN 37995

111 Clyde St
Loudon, TN 37774
Phone (865) 458-1554

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1669427142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 NIGHTINGALE LN",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092754",
            "telephone_number": "865-632-5885",
            "fax_number": "865-632-5893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 NIGHTINGALE LN",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092754",
            "telephone_number": "865-632-5885",
            "fax_number": "865-632-5893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETEZADI-AMOLI",
        "first_name": "SAEED",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD15820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3022975",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4118970",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "TN0101",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.