Samuel Mack Puckett, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD16317 Issued in TN

Practice address

1829 Crowe LN
Newport, TN 37821-7264

Phone

(423) 623-0653

Fax

(423) 625-8264

NPI assigned

Jul 17, 2006

Last updated

Jan 20, 2010By the provider in NPPES

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Newport Pediatrics, P.C.

  • Pediatrics Physician
  • Newport, TN
  • NPI 1467678706

  5% Or Greater Direct Ownership Interest

  CMS ownership

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.

• Newport Pediatrics, P.C.

  • Pediatrics Physician
  • Newport, TN
  • NPI 1467678706
  Authorized official Same address or phone

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263945600000",
    "number": "1770501819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1829 CROWE LN",
            "city": "NEWPORT",
            "state": "TN",
            "postal_code": "378217264",
            "telephone_number": "423-623-0653",
            "fax_number": "423-625-8264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1829 CROWE LN",
            "city": "NEWPORT",
            "state": "TN",
            "postal_code": "378217264",
            "telephone_number": "423-623-0653",
            "fax_number": "423-625-8264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "SAMUEL",
        "middle_name": "MACK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2010-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "MD16317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3015182",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haley Powell, PHARMD
• Premier Therapy Associates, LLC
• Norma Dennis Prizer, R.N.
• Pro Therapy Services of East Tennessee
• Professional Hearing AIDS, LLC
• Pulmacare Inc
• Hannah Raber
• Melissa Ann Reece, LPN
• Robin Reece
• Reflection Healthcare LLC

• Pediatrics Physician in Newport, TN
• Providers in Newport, TN by specialty
• Pediatrics Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.