Individual provider Active NPI

Christopher Michael Kulisek, M.D.

  • Gastroenterology Physician
  • Lenoir City, TN
National Provider Identifier
1902093537
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD50167 Issued in TN
Practice address
576 Fort Loudoun Medical Center Dr Ste 200
Lenoir City, TN 37772-5676
Phone
(865) 271-6180
Fax
(865) 374-2204
NPI assigned
Sep 27, 2007
Last updated
Jan 24, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 43568 KY
Student in an Organized Health Care Education/Training Program 390200000X
Gastroenterology Physician 207RG0100X MD50167 TN Primary

Addresses

Primary practice location

576 Fort Loudoun Medical Center Dr Ste 200
Lenoir City, TN 37772-5676

Mailing address

10810 Parkside Dr
Suite G-15
Knoxville, TN 37934-1979
Phone (865) 218-7444

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kulisek.christopher.michael@covenanthealth.cernerdirect.com

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20130729000879 TN Practitioner - Gastroenterology 2567617194 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
East Tennessee State University Quillen College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical Group IncGroup PAC ID 2860305463, 363 clinicians

Practice addresses (Care Compare)

Fort Loudoun Medical Ctr Dr
Suite 200
Lenoir City, TN 37772
Phone (865) 271-6180

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy127
Upper gastrointestinal (GI) endoscopy for acid reflux168

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group, Inc. Internal Medicine CurrentSince Jan 1, 2023 Accepting new patients
Covenant Medical Group, Inc CurrentSince Jan 1, 2023 Accepting new patients

Locations

Dept 888179
Knoxville, TN 37995

550 Fort Loudon Medical Center Dr
Ste 200
Lenoir City, TN 37772

576 Fort Loudon Medical Center Dr
Ste 200
Lenoir City, TN 37772
Phone (865) 271-6180

111 Clyde St
Loudon, TN 37774
Phone (865) 458-1554

Interoperability endpoints

  • Direct secure messaging: kulisek.christopher.michael@covenanthealth.cernerdirect.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1902093537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10810 PARKSIDE DR",
            "address_2": "SUITE G-15",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379341979",
            "telephone_number": "865-218-7444",
            "fax_number": "865-218-7445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 FORT LOUDOUN MEDICAL CENTER DR STE 200",
            "city": "LENOIR CITY",
            "state": "TN",
            "postal_code": "377725676",
            "telephone_number": "865-271-6180",
            "fax_number": "865-374-2204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULISEK",
        "first_name": "CHRISTOPHER",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-27",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "43568",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TN",
            "license": "MD50167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kulisek.christopher.michael@covenanthealth.cernerdirect.com",
            "affiliation": "N",
            "address_1": "576 Fort Loudoun Medical Center Dr Ste 200",
            "city": "Lenoir City",
            "state": "TN",
            "country_code": "US",
            "postal_code": "377725676",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lenoir City, TN

Sources for this page

Verify at the official NPI Registry.