Edward D Koonce, M.D.

Primary specialty

Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X

License

14984 Issued in TN

Practice address

620 Skyline Dr
Jackson, TN 38301-3923

Phone

(731) 541-5000

NPI assigned

Jan 12, 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 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• West Tennessee Medical Group Inc

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1053615955
  Medicare reassignment NPD

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582848000000",
    "number": "1720067283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 HIGHWAY 45 BYP STE 100",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054436",
            "telephone_number": "731-664-4220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013923",
            "telephone_number": "731-541-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOONCE",
        "first_name": "EDWARD",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-12",
        "last_updated": "2020-02-28",
        "certification_date": "2020-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "TN",
            "license": "14984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3014037",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3068372",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "930124254",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cameron Dewayne Knight, M.D.
• Carly Nicole Knight, BCBA
• Christopher Michael Knight, MD
• Nathan Allen Koenegstein, OTR/L
• Hannah Grace Cruz Kolasinski
• Alexandra Korshun, DO
• Ann M Koss, CRNA
• Virginia Anne Koubek, M.D.
• Jeffrey J Kovalic, M.D.
• Joshua Krebs, MS, LPC

• Hospice and Palliative Medicine (Internal Medicine) Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Hospice and Palliative Medicine (Internal Medicine) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.