Individual provider Active NPI

Bernard Patrick Connell, M.D.

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Chattanooga, TN
National Provider Identifier
1760417596
Registry record updated Nov 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
MD29114 Issued in TN
Practice address
910 Blackford St
Chattanooga, TN 37403-1405
Phone
(423) 778-6011
Fax
(865) 539-8008
NPI assigned
Jul 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2007

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD29114 TN
Pediatrics Physician 208000000X MD29114 TN
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X MD29114 TN Primary

Addresses

Primary practice location

910 Blackford St
Chattanooga, TN 37403-1405

Mailing address

PO Box 633819
Cincinnati, OH 45263-0001

Other identifiers 2

IdentifierTypeStateIssuer
4104252OtherTNBCBS OF TENNESSEE
3815012MedicaidTN

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20111219000279 TN Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 8729010541 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD29114TNMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Emergency Physicians of Memphis LLC Emergency Medicine CurrentSince Nov 1, 2011 Accepting new patients

Locations

910 Blackford St
Chattanooga, TN 37403
Phone (423) 778-4044

Organizations & group practices 1

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": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195603200000",
    "number": "1760417596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 633819",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452630001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 BLACKFORD ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374031405",
            "telephone_number": "423-778-6011",
            "fax_number": "865-539-8008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELL",
        "first_name": "BERNARD",
        "middle_name": "PATRICK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "MD29114",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "MD29114",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "TN",
            "license": "MD29114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENNESSEE",
            "identifier": "4104252",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3815012",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.