Richard Angelo Antonucci, MD
Individual provider Active NPI Hematology & Oncology Physician · Powell, TN
NPI 1841290541 · NPPES record last updated Oct 13, 2015
Key facts
- NPI
- 1841290541
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Hematology & Oncology Physician 207RH0003X
- License
- MD0000017010 (TN)
- Practice address
- 7551 Dannaher Way
Powell, TN 37849-4029 - Phone
- (865) 637-9330
- Fax
- (865) 859-7222
- NPI assigned
- Jul 26, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
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: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040712001553 | TN | Practitioner - Internal Medicine | 0446236574 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD0000017010 | TN | MD | Hematology & Oncology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Medical Group, PLLC | Current |
Accepting new patients | |
| Statcare Inpatient LLC | Current |
Accepting new patients | |
| Summit Medical Group, PLLC | Current |
Accepting new patients | |
| Tennessee Cancer Specialists PLLC | Hematology & Oncology | Past | Accepting new patients |
| Tennessee Cancer Specialists PLLC | Hematology & Oncology | Past | Accepting new patients |
Locations
900 E Hill Ave
Ste 230
Knoxville, TN 37915
Phone (865) 862-0998
1225 E Weisgarber Rd
Ste 200
Knoxville, TN 37909
Phone (865) 938-3627
1901 Clinch Ave
Knoxville, TN 37916
Phone (865) 331-1111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | MD0000017010 | TN | Yes |
Addresses
Primary practice location
7551 Dannaher Way
Powell, TN 37849-4029
Mailing address
726 Hampton Roads Dr
Knoxville, TN 37934-4071
Phone (865) 675-1209
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3021999 | Medicaid | TN | |
| 4082085 | Other | TN | BLUE CROSS BLUE SHIELD |
Other providers in Powell, TN
- Tonya S. Ambler
- Daniel Matthew Anderson
- Melissa B Anderson
- Sarah Anderson
- Sean Anderson
- App of East Tennessee Ed PLLC
- David W Arrington
- Aungst Corporation
- Wallace Steven Aungst
- Mandefro Ayano
All providers in Powell, TN · Hematology & Oncology Physician 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 13, 2015. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.