NPIMap

Organization Active NPI

Knoxville Center for Dermatology and Plastic Surgery, PL

  • Clinic/Center
  • Knoxville, TN
National Provider Identifier
1942703848
Registry record updated Jun 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
KNOXVILLE CENTER FOR DERMATOLOGY AND PLASTIC SURGERY, PL
Practice address
9430 Park West Blvd Ste 240
Knoxville, TN 37923
Phone
(865) 470-4127
Fax
(833) 790-3693
NPI assigned
Mar 16, 2018
Last updated
Jun 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2018

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

Authorized official

Name
Daniel P. Fowler, MDNPI 1154582450
Title
Owner
Phone
(865) 470-4124

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X TN Primary

Addresses

Primary practice location

9430 Park West Blvd Ste 240
Knoxville, TN 37923

Mailing address

PO Box 11268
Knoxville, TN 37939-1268
Phone (865) 470-4127

Other identifiers 1

IdentifierTypeStateIssuer
Q035060MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180717004224 TN Part B Supplier - Clinic/Group Practice 9436406717 Receives reassigned benefits from 4 practitioners
Practice locations: Knoxville, TN

National Provider Directory

National Provider Directory

Locations

4319 Papermill Dr
Knoxville, TN 37909
Phone (865) 470-4127

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1521158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528156800000",
    "number": "1942703848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11268",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379391268",
            "telephone_number": "865-470-4127",
            "fax_number": "833-790-3693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9430 PARK WEST BLVD STE 240",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "37923",
            "telephone_number": "865-470-4127",
            "fax_number": "833-790-3693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNOXVILLE CENTER FOR DERMATOLOGY AND PLASTIC SURGERY, PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-16",
        "last_updated": "2018-06-05",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "865-470-4124",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q035060",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.