Jacob Applegate, PA
Individual provider Active NPI Physician Assistant · Knoxville, TN
NPI 1891517249 · NPPES record last updated Mar 6, 2025
Key facts
- NPI
- 1891517249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 9320 Park West Blvd
Knoxville, TN 37923-4301 - Phone
- (865) 373-7100
- NPI assigned
- Oct 28, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Covenant Medical Group Inc
Practice addresses (Care Compare)
111 Clyde St
Loudon, TN 37774-1600
Phone (865) 458-1554
576 Fort Loudon Medical Ctr Dr
Lenoir City, TN 37772-5676
6600 Nightingale LN
Knoxville, TN 37909-2754
Phone (865) 632-5885
9330 Park W Blvd
Suite 200
Knoxville, TN 37923-4310
Phone (865) 373-5100
9352 Park W Blvd
Knoxville, TN 37923-4325
Phone (865) 373-1974
Hospital & facility affiliations
- Parkwest Medical Center
- Fort Loudoun Medical Center
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 |
|---|---|---|---|---|
| I20250501002030 | TN | Practitioner - Physician Assistant | 7416473509 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6406 | TN | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Covenant Medical Group, Inc. | Physician Assistant | Current |
Accepting new patients |
| Covenant Medical Group, Inc | Current |
Accepting new patients |
Locations
Dept 888179
Knoxville, TN 37995
9320 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-7100
111 Clyde St
Loudon, TN 37774
Phone (865) 458-1554
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 6406 | TN | |
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
9320 Park West Blvd
Knoxville, TN 37923-4301
Mailing address
9320 Park West Blvd
Knoxville, TN 37923-4301
Phone (865) 373-1700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q099989 | Medicaid | TN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | applegate.jacob@covenanthealth.cernerdirect.com |
Other providers in Knoxville, TN
- Shanthi Appelo
- Apple Healthcare Group
- Apple Healthcare Group, PC
- Marc G Apple
- Maria Christina Appleberry
- Edith Fowler Appleton
- Appliance Place LLC
- Apria Healthcare LLC
- Apria Healthcare, Inc.
- Apricott LLC
All providers in Knoxville, 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 Mar 6, 2025. 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.