Individual provider Active NPI

Karen Gayl Ekwueme, M.D.

  • Family Medicine Physician
  • Chattanooga, TN
National Provider Identifier
1720183890
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
66165 Issued in TN
Practice address
1521 Gunbarrel Rd # 103
Chattanooga, TN 37421-3124
Phone
(423) 531-0911
Fax
(423) 531-0912
NPI assigned
Sep 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 66165 TN Primary

Addresses

Primary practice location

1521 Gunbarrel Rd # 103
Chattanooga, TN 37421-3124

Mailing address

1025 Peerless Xing NW
Cleveland, TN 37312-3764
Phone (423) 476-5990

Other identifiers 1

IdentifierTypeStateIssuer
61036OtherWIDEAN HEALTH SYSTEMS, INC

Other names 1

  • Karen Gayl King Former name

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: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221117002011 TN Practitioner - Family Practice 5193612687 Reassigns benefits to 1 organization
I20260320003393 GA Practitioner - Family Practice 5193612687 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

590 Lanier Ave W
Fayetteville, GA 30214-1504

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
66165TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DX Mso, PLLC CurrentSince Aug 20, 2023 Accepting new patients
Metro Treatment of Georgia, LP CurrentSince May 6, 2014 Accepting new patients
Afc Urgent Care and Family Care of WNC, PLLC PastSince Aug 20, 2023 Accepting new patients
Advocate North Side Health Network Past Accepting new patients

Locations

700 E 54th St N
Sioux Falls, SD 57104
Phone (423) 458-1426

1521 Gunbarrel Rd
#103
Chattanooga, TN 37421
Phone (423) 531-0911

1521 Gunbarrel Rd
Ste 103
Chattanooga, TN 37421
Phone (423) 458-1426

1025 Peerless Xing NW
Cleveland, TN 37312
Phone (423) 476-5990

Interoperability endpoints

  • Direct secure messaging: karen.ekwueme.npi1720183890.reliant@direct.optumcare.masshiway.net

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1720183890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 PEERLESS XING NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373123764",
            "telephone_number": "423-476-5990",
            "fax_number": "423-476-5887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 GUNBARREL RD # 103",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374213124",
            "telephone_number": "423-531-0911",
            "fax_number": "423-531-0912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EKWUEME",
        "first_name": "KAREN",
        "middle_name": "GAYL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "66165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH SYSTEMS, INC",
            "identifier": "61036",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAREN",
            "last_name": "KING",
            "middle_name": "GAYL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.