NPIMap

Individual provider Active NPI

Robert Joseph Wilson, M.D.

  • Family Medicine Physician
  • Harriman, TN
National Provider Identifier
1982698155
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30880 Issued in TN
Practice address
1855 Tanner Way
Harriman, TN 37748-8302
Phone
(865) 376-6272
Fax
(865) 376-0341
NPI assigned
Sep 2, 2005
Last updated
Jun 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 30880 TN Primary

Addresses

Primary practice location

1855 Tanner Way
Harriman, TN 37748-8302

Mailing address

1855 Tanner Way
Harriman, TN 37748-8302
Phone (865) 376-6272

Other identifiers 3

IdentifierTypeStateIssuer
3835683MedicaidTN
Q066116MedicaidTN
3835683OtherTNRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100909000916 TN Practitioner - Family Practice 2163481268 Reassigns benefits to 1 organization
Practice locations: Harriman, TN

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical School at San Antonio, 1997
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)

1855 Tanner Way
Suite 220
Harriman, TN 37748-8332
Phone (865) 882-2442

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30880TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group, Inc. Family Medicine CurrentSince Aug 1, 2021 Accepting new patients
Covenant Medical Group, Inc CurrentSince Aug 1, 2021 Accepting new patients
First Care Medical Center PC Past Accepting new patients
W E Bennett MD Past Accepting new patients

Locations

1855 Tanner Way
Ste 200
Harriman, TN 37748
Phone (865) 376-6272

1855 Tanner Way
Ste 220
Harriman, TN 37748
Phone (865) 882-2442

Dept 888179
Knoxville, TN 37995

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

Organizations & group practices 4

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 6

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": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1982698155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 TANNER WAY",
            "city": "HARRIMAN",
            "state": "TN",
            "postal_code": "377488302",
            "telephone_number": "865-376-6272",
            "fax_number": "865-376-0341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 TANNER WAY",
            "city": "HARRIMAN",
            "state": "TN",
            "postal_code": "377488302",
            "telephone_number": "865-376-6272",
            "fax_number": "865-376-0341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ROBERT",
        "middle_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "30880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3835683",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q066116",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "3835683",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harriman, TN

Sources for this page

Verify at the official NPI Registry.