Steven Gordon Gunderson, PA-C
Individual provider Active NPI Physician Assistant · Talbott, TN
NPI 1790407286 · NPPES record last updated Oct 26, 2022
Key facts
- NPI
- 1790407286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 6890 W Andrew Johnson Hwy
Talbott, TN 37877-8610 - Phone
- (423) 839-2120
- NPI assigned
- Sep 13, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Lincoln Memorial University Medical Department, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Phillips Healthcare Group, PC
Practice addresses (Care Compare)
6890 W a J Hwy
Talbott, TN 37877
Phone (423) 839-2120
PO Box
Suite 879
Talbott, TN 37877
Hospital & facility affiliations
- Tennova Healthcare-Jefferson Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221214000469 | TN | Practitioner - Physician Assistant | 8123497195 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5286 | TN | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
6890 W Andrew Johnson Hwy
Talbott, TN 37877-8610
Mailing address
2601 N John B Dennis Hwy Apt 1901
Kingsport, TN 37660-0828
Phone (507) 589-9271
Other practice location 1
2601 N John B Dennis Hwy Apt 1901
Kingsport, TN 37660-0828
Phone (507) 589-9271
Other providers in Talbott, TN
- Ethel M Glenn
- Annie Grantham
- Julie Roach Gray
- Kimberly Susan Greene
- Julianna Smith Gregory
- Courtney Amber Hall
- Gary Steven Harbin
- Emma Therese Healy
- Laurel Elise Henegar
- Melissa Dawn Hess
All providers in Talbott, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.