NPIMap

Individual provider Active NPI

Carl Warren Rose, PA-C

  • Medical Physician Assistant
  • Westmoreland, TN
National Provider Identifier
1740326495
Registry record updated Aug 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA265 Issued in TN
Practice address
12124 Highway 52 W Ste 5
Westmoreland, TN 37186-3257
Phone
(615) 644-3000
Fax
(615) 644-3076
NPI assigned
Jan 29, 2007
Last updated
Aug 8, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA265 TN Primary

Addresses

Primary practice location

12124 Highway 52 W Ste 5
Westmoreland, TN 37186-3257

Mailing address

PO Box 595
Westmoreland, TN 37186-0595
Phone (615) 644-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120111000275 TN Practitioner - Physician Assistant 9830366038 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rose Family ClinicGroup PAC ID 6406022664, 4 clinicians

Practice addresses (Care Compare)

12124 Hwy 52 W
Suite 5
Westmoreland, TN 37186-3257
Phone (615) 644-3000

PO Box
Suite 595
Westmoreland, TN 37186

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
KSC, Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: carl.rose.1@24545.direct.athenahealth.com

Organizations & group practices 3

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 6

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": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1740326495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 595",
            "city": "WESTMORELAND",
            "state": "TN",
            "postal_code": "371860595",
            "telephone_number": "615-644-3000",
            "fax_number": "615-644-3076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12124 HIGHWAY 52 W STE 5",
            "city": "WESTMORELAND",
            "state": "TN",
            "postal_code": "371863257",
            "telephone_number": "615-644-3000",
            "fax_number": "615-644-3076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "CARL",
        "middle_name": "WARREN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "PA265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westmoreland, TN

Sources for this page

Verify at the official NPI Registry.