Individual provider Active NPI

Nicholas J Pons, PA-C

  • Physician Assistant
  • Chattanooga, TN
National Provider Identifier
1689959561
Registry record updated Oct 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2027 Issued in TN
Practice address
2525 Desales Avenue
Chattanooga, TN 37404
Phone
(423) 697-0014
Fax
(423) 648-6280
NPI assigned
Oct 11, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2027 TN Primary

Addresses

Primary practice location

2525 Desales Avenue
Chattanooga, TN 37404

Mailing address

725 Glenwood Drive
Suite E-487
Chattanooga, TN 37404
Phone (423) 697-0014

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20111202000709 TN Practitioner - Physician Assistant 7810162872 Reassigns benefits to 1 organization
I20210323000282 GA Practitioner - Physician Assistant 7810162872 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Chattanooga Emergency Medicine PLLC CurrentSince Apr 1, 2019 Accepting new patients

Locations

2525 Desales Ave
Chattanooga, TN 37404
Phone (423) 495-2620

725 Glenwood Dr
Ste E487
Chattanooga, TN 37404
Phone (423) 697-0014

Organizations & group practices 2

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": "1318291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318291200000",
    "number": "1689959561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 GLENWOOD DRIVE",
            "address_2": "SUITE E-487",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37404",
            "telephone_number": "423-697-0014",
            "fax_number": "423-648-6280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 DESALES AVENUE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37404",
            "telephone_number": "423-697-0014",
            "fax_number": "423-648-6280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONS",
        "first_name": "NICHOLAS",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-11",
        "last_updated": "2011-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.