Jaan Kelly, PA-C
Individual provider Active NPI Medical Physician Assistant · Knoxville, TN
NPI 1831189190 · NPPES record last updated Dec 9, 2010
Key facts
- NPI
- 1831189190
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 1072 (TN)
- Practice address
- 9330 Park West Blvd
Suite 202
Knoxville, TN 37923-4308 - Phone
- (865) 691-4850
- Fax
- (865) 694-8018
- NPI assigned
- Oct 26, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Family Medicine West PLLC
Practice addresses (Care Compare)
220 Fort Sanders W Blvd
BLDG. 2 Suite 200
Knoxville, TN 37922
Phone (865) 288-4232
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 |
|---|---|---|---|---|
| I20041101001084 | TN | Practitioner - Physician Assistant | 6901868090 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Medicine West PLLC | Current |
Accepting new patients | |
| Covenant Medical Group, Inc. | Current |
Accepting new patients | |
| Saint Thomas Medical Partners | Current |
Accepting new patients | |
| Covenant Medical Group, Inc | Current |
Accepting new patients | |
| Cardiovascular Specialist , P.C. | Past | Accepting new patients | |
| Specialty Physician Group LLC | Medical | Past | Accepting new patients |
| Knoxville Mindful Wellness Center, LLC | Past |
Accepting new patients |
Locations
9320 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-7100
220 Fort Sanders West Blvd
Ste 200
Knoxville, TN 37922
Phone (423) 346-5566
Dept 888179
Knoxville, TN 37995
550 Fort Loudoun Med Center Dr
Lenoir City, TN 37772
Phone (865) 271-6000
111 Clyde St
Loudon, TN 37774
Phone (865) 458-1554
300 20th Ave N
Fl 9
Nashville, TN 37203
744 Middle Creek Rd
Ste 114
Sevierville, TN 37862
Phone (865) 446-9575
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 1072 | TN | Yes |
Addresses
Primary practice location
9330 Park West Blvd
Suite 202
Knoxville, TN 37923-4308
Mailing address
9330 Park West Blvd
Suite 202
Knoxville, TN 37923-4308
Phone (865) 691-4850
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3661893 | Medicaid | TN |
Other providers in Knoxville, TN
- Christine Laurel Ann Kelly
- Dana Elizabeth Kelly
- Donna June Kelly
- Elizabeth Rowan Kelly
- Erin Kelly
- Lauren Elizabeth Kelly
- Melanie W. Kelly
- Michael Edward Kelly
- Paul Kelly
- Thomas J Kelly
All providers in Knoxville, TN · Medical 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 Dec 9, 2010. 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.