NPIMap

Individual provider Active NPI

Darryl John Wilkens, M.D.

  • Family Medicine Physician
  • Jellico, TN
National Provider Identifier
1679678429
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD0000030038 Issued in TN
Practice address
131 Hospital LN
Jellico, TN 37762-4404
Phone
(423) 784-7269
Fax
(423) 784-3708
NPI assigned
Sep 14, 2006
Last updated
Mar 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35440 KY
Family Medicine Physician 207Q00000X MD0000030038 TN Primary

Addresses

Primary practice location

131 Hospital LN
Jellico, TN 37762-4404

Mailing address

PO Box 447
Jellico, TN 37762-0447
Phone (423) 784-7269

Other practice location 1

475 N Highway 25 W Ste 100
Williamsburg, KY 40769-1576
Phone (606) 549-2930

Other identifiers 2

IdentifierTypeStateIssuer
3836057MedicaidTN
64712748MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, KY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100830000777 TN Practitioner - Family Practice 2961526876 Reassigns benefits to 1 organization
I20160225001145 KY Practitioner - Family Practice 2961526876 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loma Linda University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charles H. Wilkens, M.D.,P.C.Group PAC ID 8224073432, 3 clinicians
Williamsburg Family Medicine CenterGroup PAC ID 2365331188, 7 clinicians

Practice addresses (Care Compare)

131 Hospital LN
Jellico, TN 37762-4404
Phone (423) 784-7269

475 N Hwy 25 W
Williamsburg, KY 40769-1576
Phone (606) 549-2930

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD0000030038TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Charles H. Wilkens, M.D.,P.C. CurrentSince Aug 1, 1999 Accepting new patients
Highland Park Primary Care Center, PLLC Past Accepting new patients
Jellico TN Opco LLC Past Accepting new patients

Locations

131 Hospital Ln
Jellico, TN 37762
Phone (423) 784-7269

Interoperability endpoints

  • Direct secure messaging: darryl.wilkens.1@24159.direct.athenahealth.com
  • Direct secure messaging: dwilkens@chw03.gwaydirect.com
  • Direct secure messaging: dwilkens@wfmc.gwaydirect.com
  • FHIR API: https://api.platform.athenahealth.com/24159/brand/1/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Williamsburg Family Medicine CenterWilliamsburg, KY, CCN 183832 Rural health clinic 5% Or Greater Direct Ownership Interest (33%)
W-2 Managing Employee		 Dec 27, 2021
Dec 27, 2021
Charles H. Wilkens, M.D.,P.C.Jellico, TN, CCN 443925 Rural health clinic 5% Or Greater Direct Ownership Interest (33%)
Corporate Director (100%)
W-2 Managing Employee		 Dec 21, 2021
Sep 30, 2015
Dec 27, 2021

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1679678429",
    "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": [
        {
            "address_1": "475 N Highway 25 W Ste 100",
            "address_purpose": "LOCATION",
            "city": "Williamsburg",
            "state": "KY",
            "postal_code": "407691576",
            "country_code": "US",
            "telephone_number": "606-549-2930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKENS",
        "first_name": "DARRYL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "35440",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD0000030038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3836057",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64712748",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jellico, TN

Sources for this page

Verify at the official NPI Registry.