Charlie Etherton, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA0842 Issued in TN

Practice address

1124 Fox Meadows Blvd
Suite 2
Sevierville, TN 37862-6927

Phone

(865) 453-5530

Fax

(865) 453-2671

NPI assigned

Aug 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Summit Medical Group, PLLCGroup PAC ID 2860396330, 636 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Amedisys Home Health Care Home health agency, Knoxville, TN, CCN 447312
• University of TN Medical Center Home Care Services Home health agency, Knoxville, TN, CCN 447230
• Leconte Medical Center Hospital, Sevierville, TN, CCN 440081
• University Health System, Inc Hospital, Knoxville, TN, CCN 440015

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: charlie.etherton.1@20785.direct.athenahealth.com

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.

• Summit Medical Group, PLLC

  dba Cool Springs Internal Medicine and Pediatrics

  • Internal Medicine Physician
  • Brentwood, TN
  • NPI 1659090298
  Medicare reassignment Care Compare group NPD
• Summit Medical Group, PLLC

  dba Halls Family Physicians

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1861571028
  NPD
• Summit Medical Group, PLLC

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1699722470
  NPD (past)

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

• Comprehensive Home Healthcare Services LLC

  dba Amedisys Home Health Care

  • Home Health Agency
  • Knoxville, TN
  • NPI 1710935408
  Care Compare affiliation
• Leconte Medical Center

  • General Acute Care Hospital
  • Sevierville, TN
  • NPI 1528052578
  Care Compare affiliation
• University Health System, Inc.

  dba University of Tennessee Medical Center

  • General Acute Care Hospital
  • Knoxville, TN
  • NPI 1538164090
  Care Compare affiliation
• University of TN Medical Center Home Care Services, LLC

  dba University of TN Medical Center Home Care Services - Home Health

  • Home Health Agency
  • Knoxville, TN
  • NPI 1346460953
  Care Compare affiliation

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587600000000",
    "number": "1700990025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 DICK LONAS RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379091382",
            "telephone_number": "865-584-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 FOX MEADOWS BLVD",
            "address_2": "SUITE 2",
            "city": "SEVIERVILLE",
            "state": "TN",
            "postal_code": "378626927",
            "telephone_number": "865-453-5530",
            "fax_number": "865-453-2671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHERTON",
        "first_name": "CHARLIE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "PA0842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "P00339849",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Empowerme Rehabilitation, LLC
• Kristen Endzel, FNP
• English Mountain Recovery
• Abigail Denise Eslinger
• Douglas Estey, PAC
• Eye Care Associates of Sevier County
• Destin Nichole Faria, MHS, RD, LDN
• Fast Pace Medical Clinic PLLC
• Jason Lynn Fee, PA
• Janis H Felty, SLP

• Physician Assistant in Sevierville, TN
• Providers in Sevierville, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; 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.