Kelvin L. Douglas, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

26349 Issued in TN

Practice address

2156-B N. Highland Ave
Ste 282
Jackson, TN 38305

Phone

(731) 499-2791

Fax

(731) 285-5200

NPI assigned

Jun 6, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Locum Tenens Healthcare

  • Primary Care Clinic/Center
  • Memphis, TN
  • NPI 1992901128
  NPD (past) Authorized official
• Bolivar General Hospital, Inc.

  dba Bolivar ER

  • General Acute Care Hospital
  • Bolivar, TN
  • NPI 1174545446
  NPD (past)
• Bolivar General Hospital, Inc.

  dba West Tennessee Healthcare Bolivar Hospital

  • Critical Access Hospital
  • Bolivar, TN
  • NPI 1518957950
  NPD (past)
• Hospitalists of Jackson LLC

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1164480893
  NPD (past)

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1982643482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 WOODLAWN AVE",
            "address_2": "STE A",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "38024",
            "telephone_number": "731-287-1500",
            "fax_number": "731-285-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2156-B N. HIGHLAND AVE",
            "address_2": "STE 282",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "38305",
            "telephone_number": "731-499-2791",
            "fax_number": "731-285-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "KELVIN",
        "middle_name": "L.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "26349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171276",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "4106545",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3090776",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35464",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4106545",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17154",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Jae Donnelly
• Doris Doss, CRISIS CLINICIAN
• Jake Hunter Doster, D.C.
• Christopher A Douglas, DC
• Hope Douglas, FNP
• Kyle David Douglas, MSW
• Laquisha Douglas, MSN, APRN, PMHNP-BC
• Joshua Downey, DO
• Downtown Vision Center, P.C.
• Seth Doyle

• Internal Medicine Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.