Edward Trent McNeeley, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD0000011390 Issued in TN

Practice address

110 Executive Park Lane
Clinton, TN 37716

Phone

(865) 494-9241

Fax

(865) 494-2522

NPI assigned

Oct 13, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Covenant Medical Group, Inc.

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1457302010
  Medicare reassignment NPD
• Covenant Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Knoxville, TN
  • NPI 1871269415
  NPD
• Crossville Medical Group PA

  • Multi-Specialty Clinic/Center
  • Crossville, TN
  • NPI 1053414698
  NPD (past)

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1932197845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 EXECUTIVE PARK LANE",
            "city": "CLINTON",
            "state": "TN",
            "postal_code": "37716",
            "telephone_number": "865-494-9241",
            "fax_number": "865-494-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 EXECUTIVE PARK LANE",
            "city": "CLINTON",
            "state": "TN",
            "postal_code": "37716",
            "telephone_number": "865-494-9241",
            "fax_number": "865-494-2522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNEELEY",
        "first_name": "EDWARD",
        "middle_name": "TRENT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD0000011390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080097218",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3181999",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "2001058",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sierra Cheyenne McCullah
• Alexandra Maria McKane, DO
• Kimberly Marie McMahan
• Ann S McMurray, SLP
• Ashlie McNeeley, PHARM.D.
• Howard B McNeeley, M.D.
• Jilliane Lee McNew, FNP-BC
• Meadow View Senior Living
• Crystal Michelle Mealer, OT
• Alma Meraz

• Family Medicine Physician in Clinton, TN
• Providers in Clinton, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.