JAMES M CARLSON DO
NPI 1174568315
Family Medicine in Knoxville, TN
NPI Status: Active since June 19, 2006
Contact Information
7211 WELLINGTON DR
SUITE 201
KNOXVILLE, TN
ZIP 37919
Phone: (865) 584-5762
- Individual
- Male
- Family Medicine
- PECOS Enrolled
- Opted-Out Medicare
About JAMES CARLSON
This page provides the complete NPI Profile along with additional information for James Carlson, a primary care provider established in Knoxville, Tennessee with a medical specialization in Family Medicine. The healthcare provider is registered in the NPI registry with number 1174568315 assigned on June 2006. The practitioner's primary taxonomy code is 207Q00000X with license number 1048 (TN). The provider is registered as an individual and his NPI record was last updated 17 years ago.
- NPI
- 1174568315
- Provider Name
- JAMES M CARLSON DO
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 7211 WELLINGTON DR SUITE 201 KNOXVILLE, TN 37919
- Location Phone
- (865) 584-5762
- Mailing Address
- 1225 E WEISGARBER RD SUITE 200 KNOXVILLE, TN 37909
- Mailing Phone
- (865) 584-4747
- Is Sole Proprietor?
- No
- Enumeration Date
- 06-19-2006
- Last Update Date
- 09-23-2008
- Code Navigator
A primary care provider (PCP) like James Carlson sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. James Carlson opted out of Medicare effective on 07-01-2018 until 07-01-2026. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare but is permitted to order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Family Medicine
- Taxonomy Code
- 207Q00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 1048
- License State
- TN
- Taxonomy Description
- Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 3717544 | MEDICARE ID-TYPE UNSPECIFIED (04) | TN | LEGACY GROUP |
| 3304238 | MEDICARE ID-TYPE UNSPECIFIED (04) | TN | LEGACY PIN |
| 3304235 | MEDICAID (05) | TN | |
| 930041887 | OTHER (01) | TN | RR MEDICARE |
| G18086 | MEDICARE UPIN (02) |
Medicare Participation & PECOS Enrollment Status
James Carlson is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 07-01-2018
Opt-Out End Date: 07-01-2026
Eligible to Order and Refer? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Physician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 37919 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $81.53
- Minimum New Patient Price $52.64
- Maximum New Patient Price $160.89
- Average New Patient Copayment $20.38
- Minimum New Patient Copayment $13.16
- Maximum New Patient Copayment $40.22
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $93.6
- Minimum Established Patient Price $16.72
- Maximum Established Patient Price $131.41
- Average Established Patient Copayment $23.4
- Minimum Established Patient Copayment $4.18
- Maximum Established Patient Copayment $32.85
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Reviews for JAMES M CARLSON DO
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 1 | 7 | 4 | 5 | 6 | 8 | 3 | 1 | 5 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 1 | 14 | 4 | 10 | 6 | 16 | 3 | 2 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 1 + 1 + 4 + 4 + 1 + 0 + 6 + 1 + 6 + 3 + 2 + 24 = 55 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 55 = 5 | 5 | ||||||||
The NPI number 1174568315 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1356386593 | JOHN T BUSHORE MD Individual | Family Medicine | 7211 WELLINGTON DR SUITE 201 KNOXVILLE, TN 37919 (865) 584-5762 |
| 1275579187 | LEONARD F BELLINGRATH MD Individual | Family Medicine | 7211 WELLINGTON DR SUITE 201 KNOXVILLE, TN 37919 (865) 584-5762 |
| 1609812460 | MICHAEL V OTIS MD Individual | Family Medicine | 7211 WELLINGTON DR STE 201 KNOXVILLE, TN 37919 (865) 584-5762 |
| 1548297526 | ARMAND C WOOD MD Individual | Family Medicine | 7211 WELLINGTON DR STE 201 KNOXVILLE, TN 37919 (865) 584-5762 |
| 1821025818 | WARREN B SAYRE MD Individual | Family Medicine | 7211 WELLINGTON DR STE 102 KNOXVILLE, TN 37919 (865) 558-9822 |
| 1023178498 | CYNTHIA E. SIMMONS PA Individual | Physician Assistant | 7211 WELLINGTON DR SUITE 101 KNOXVILLE, TN 37919 (865) 558-9822 |
| 1386793305 | MRS. JULIA BETH GALANTI PA-C Individual | Physician Assistant (Medical) | 7211 WELLINGTON DR SUITE 102 KNOXVILLE, TN 37919 (865) 558-9822 |
| 1679547343 | KANDENNA GREENE NP Individual | Nurse Practitioner | 7211 WELLINGTON DR SUITE 102 KNOXVILLE, TN 37919 (865) 584-4747 |
| 1235175852 | THOMAS I ANDERSON MD Individual | Family Medicine | 7211 WELLINGTON DR SUITE 201 KNOXVILLE, TN 37919 (865) 584-5762 |
| 1912949975 | MR. RALPH RUSSELL DAILEY IV P.A. Individual | Physician Assistant | 7211 WELLINGTON DR KNOXVILLE, TN 37919 (865) 584-4747 |
| 1033407614 | ADAM CHRISTOPHER LETT MD Individual | Family Medicine | 7211 WELLINGTON DR SUITE 201 KNOXVILLE, TN 37919 (865) 584-5762 |
| 1053705756 | ASHLEY L. RHYNE FNP Individual | Nurse Practitioner (Family) | 7211 WELLINGTON DR SUITE 201 KNOXVILLE, TN 37919 (865) 584-5762 |
| 1043508625 | MALLORY IRWIN TREVINO MD Individual | Family Medicine | 7211 WELLINGTON DR SUITE 201 KNOXVILLE, TN 37919 (865) 584-5762 |
| 1831135482 | JOHN C. RYLANDS MD Individual | Family Medicine | 7211 WELLINGTON DR STE 201 KNOXVILLE, TN 37919 (865) 584-5762 |
| 1629157292 | SUMMIT MEDICAL GROUP, PLLC Organization | Family Medicine | 7211 WELLINGTON DR SUITE 201 KNOXVILLE, TN 37919 (865) 584-5762 |
| 1497067045 | EMILY MITHOEFER EDWARDS DO Individual | Family Medicine | 7211 WELLINGTON DR KNOXVILLE, TN 37919 (865) 584-5762 |
| 1700234523 | BRYAN A KERR PA Individual | Physician Assistant | 7211 WELLINGTON DR KNOXVILLE, TN 37919 (865) 584-5762 |
| 1831644905 | LOY S. BOWLAND PA Individual | Physician Assistant | 7211 WELLINGTON DR SUITE 201 KNOXVILLE, TN 37919 (865) 584-5762 |
| 1821251166 | DR. MATTHEW RYAN BESSOM M.D. Individual | Internal Medicine | 7211 WELLINGTON DR KNOXVILLE, TN 37919 (865) 584-5762 |
| 1174939789 | TIMOTHY WILLIAMS DO Individual | Family Medicine | 7211 WELLINGTON DR KNOXVILLE, TN 37919 (865) 584-5762 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1174568315, enumerated in the NPI registry as an "individual" on June 19, 2006
The provider is located at 7211 Wellington Dr Suite 201 Knoxville, Tn 37919 and the phone number is (865) 584-5762
The provider's speciality is Family Medicine with taxonomy code 207Q00000X
The provider might be accepting Accepts: Medicare, Medicaid and Railroad Medicare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $81.53 with an average copayment of $20.38 for new patient appointments. Established patients should expect a typical charge of $93.6 and an average copayment of 23.4. Please review your insurance plan or contact the provider directly to determine your specific costs.
No, the provider signed an affidavit on July 01, 2018 to opt-out of the Medicare program. The provider is excluded from the Medicare program until July 01, 2026.
This NPI record was last updated on June 19, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.