Katie Greene Pegram, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

51676 Issued in TN

Practice address

490 Dunlop LN
Clarksville, TN 37040-5007

Phone

(931) 245-8400

NPI assigned

May 17, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Miss Katie Marie Greene Former name

Electronic endpoints 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

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.

• Premier Medical Group PC

  • General Practice Physician
  • Clarksville, TN
  • NPI 1740242957
  Medicare reassignment NPD
• Eyesthetics PLLC

  • Ophthalmology Physician
  • Clarksville, TN
  • NPI 1598374902
  NPD
• Abcd Pediatrics

  • Pediatrics Physician
  • San Antonio, TX
  • NPI 1841280278
  NPD (past)

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

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1780977207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3799",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370433799",
            "telephone_number": "931-245-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 DUNLOP LN",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370405007",
            "telephone_number": "931-245-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEGRAM",
        "first_name": "KATIE",
        "middle_name": "GREENE",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-17",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "51676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q028432",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "katie.pegram.2@7977.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "Premier Medical Group PC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "490 Dunlop Ln",
            "city": "Clarksville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "370405007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "GREENE",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nancy P Pedigo Wilkinson, LMFT
• William Joel Pedigo, MD
• Pedro T. Salcedo, M.D.,PLC
• Lastacia Peele
• Brandy Denise Peet
• Trey Amerson Pegram, M.D.
• Emily Pellham
• Alicia Pendleton
• Erica Penko, BCBA
• Danica Pennington

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; 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.