NPIMap

Organization Active NPI

Edmunds Gastroenterology, PLLC

  • Gastroenterology Physician
  • Knoxville, TN
National Provider Identifier
1972084069
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD26426 Issued in TN
Legal business name
EDMUNDS GASTROENTEROLOGY, PLLC
Practice address
4713 Papermill Dr
Knoxville, TN 37909-1908
Phone
(865) 851-7771
Fax
(865) 851-7835
NPI assigned
Aug 27, 2018
Last updated
Aug 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2021

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

Authorized official

Name
Pat Jenkins
Title
Credentialing Specialist
Phone
(865) 740-1095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X MD26426 TN Primary

Addresses

Primary practice location

4713 Papermill Dr
Knoxville, TN 37909-1908

Mailing address

4713 Papermill Dr Ste 100
Knoxville, TN 37909-1924
Phone (865) 851-7771

Other identifiers 1

IdentifierTypeStateIssuer
Q008655MedicaidTN

Other names 1

  • Meade C. Edmunds, M.D. Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181120000905 TN Part B Supplier - Clinic/Group Practice 4486908969 Receives reassigned benefits from 15 practitioners
Practice locations: Knoxville, TN; Lenoir City, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2162595Edmunds Gastroenterology, PLLC4713 Papermill Dr, Ste 100, Knoxville, TN 37909ComplianceSep 27, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1535328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628467200000",
    "number": "1972084069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4713 PAPERMILL DR STE 100",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379091924",
            "telephone_number": "865-851-7771",
            "fax_number": "865-851-7835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4713 PAPERMILL DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379091908",
            "telephone_number": "865-851-7771",
            "fax_number": "865-851-7835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDMUNDS GASTROENTEROLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-27",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "PAT",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "865-740-1095"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TN",
            "license": "MD26426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q008655",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meade C. Edmunds, M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Aug 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.