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DR. JAMES MARTIN MCLOUGHLIN M.D.
NPI 1376745653
Surgery - Surgical Oncology in Knoxville, TN

Active since May 31, 2007PECOS EnrolledAccepts Medicare Assignment
95.69/100
CMS Quality Rating
1934 ALCOA HWY, SUITE 476, KNOXVILLE, TN 37920(865) 544-9218(865) 305-8262 Get Directions Write a Review

NPPES record last updated: April 4, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. James Martin Mcloughlin M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JAMES MARTIN MCLOUGHLIN M.D. (NPI 1376745653) is an individual surgical oncology provider in Knoxville, Tennessee, licensed in Georgia (059478) and active in the NPI registry since May 2007. He is enrolled in Medicare PECOS, is affiliated with University Health System, Inc, and is a graduate of Rush Medical College Of Rush University (2000).

NPPES Registry Identity

NPI1376745653
Entity TypeIndividualMale
Primary Taxonomy2086X0206X
Provider Legal NameDR. JAMES MARTIN MCLOUGHLINCredential: M.D.
Location Address1934 ALCOA HWY, SUITE 476Knoxville, TN 37920-1524
Mailing Address1934 Alcoa Hwy, Suite 476Knoxville, TN 37920-1524 · (865) 544-9218 · Fax (865) 305-8262
Phone(865) 544-9218
Fax(865) 305-8262
Sole ProprietorNo
Medical School CMSRush Medical College Of Rush UniversityGraduated 2000
Enumeration DateMay 31, 2007
Last NPPES UpdateApril 4, 2012
✔ NPI 1376745653 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Surgical OncologyAllopathic & Osteopathic Physicians
Taxonomy Code2086X0206X
License✔ Licensed in GA · 059478
Definition
A surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevention, diagnosis, treatment, and rehabilitation of cancer patients, and devotes a major portion of his or her professional practice to these activities and cancer research.
1934 ALCOA HWY, Knoxville, TN 37920
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BlueCross BlueShield of Tennessee, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. James Martin Mcloughlin M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2163515164
PECOS Enrollment IDI20120307000645
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
40 services40 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
31 services29 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
30 services27 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
27 services27 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
19 services19 patients
Repair of abdomen using abdominal lining graft 49905
This procedure involves repairing a damaged part of your abdomen with a graft, or patch, made from your own abdominal lining. It aims to strengthen the area and promote healing. Rest assured, it's performed by skilled surgeons.
14 services14 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

University Health System, Inc

Acute Care Hospitals · Knoxville, TN
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number440015
Location1924 Alcoa HighwayKnoxville, TN 37920 · Knox County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37920 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$160.89 typical visit price
range $52.64 – $160.89
Typical copayment $40.22 (range $13.16 – $40.22)
Most-billed visit code 99205
Established Patient
$66.01 typical visit price
range $16.72 – $131.41
Typical copayment $16.50 (range $4.18 – $32.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

95.69/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality85.28
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each A4409
DME-Orthotic Devices · category DF010N
3 suppliers13 claims350 services$5.66 avg. paid by Medicare
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape B4035
Other-Enteral and Parenteral · category OB006N
1 supplier22 claims229 services$1.38 avg. paid by Medicare
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit B4152
Other-Enteral and Parenteral · category OB006N
2 suppliers13 claims2,868 services$0.12 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JAMES MICHAEL LEWIS M.D.
Surgery (Surgical Oncology)
1934 ALCOA HWY, SUITE 476
KNOXVILLE, TN 37920
Knox County (865) 544-9218
SONYA RENEE MCWILLIAMS FNP
Nurse Practitioner
1934 ALCOA HWY, BLDG D SUITE 285
KNOXVILLE, TN 37920
Knox County (865) 305-9620
KRISTOPHER J. KIMBALL MD
Obstetrics & Gynecology (Gynecologic Oncology)
1934 ALCOA HWY, STE 478
KNOXVILLE, TN 37920
Knox County (865) 305-5622
LANDON MARK JOHNSON PHARMD
Pharmacist
1934 ALCOA HWY
KNOXVILLE, TN 37920
Knox County (865) 305-9124
MRS. AMANDA WILSON BERRY CNP
Nurse Practitioner (Family)
1934 ALCOA HWY, SUITE 476
KNOXVILLE, TN 37920
Knox County (865) 544-9218
DR. NIKITA N/A WADHWANI
Colon & Rectal Surgery
1934 ALCOA HWY
KNOXVILLE, TN 37920
Knox County (205) 934-9600
UNIVERSITY HEALTH SYSTEM, INC
Surgery
1934 ALCOA HWY, STE 370
KNOXVILLE, TN 37920
Knox County (865) 305-9620
DR. JULIO ANTONIO SOLLA M.D.
Colon & Rectal Surgery
1934 ALCOA HWY, SUITE D-370
KNOXVILLE, TN 37920
Knox County (865) 305-5335

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is James Mcloughlin's NPI number?

The NPI number for James Mcloughlin is 1376745653. It was assigned to this individual provider in the NPPES registry on May 31, 2007.

Where is James Mcloughlin located?

James Mcloughlin practices at 1934 Alcoa Hwy Suite 476, Knoxville, TN 37920. The listed phone number is (865) 544-9218.

What is James Mcloughlin's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Surgical Oncology, with taxonomy code 2086X0206X.

Is James Mcloughlin enrolled in Medicare?

Yes. James Mcloughlin is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does James Mcloughlin accept?

Health plans from BlueCross BlueShield of Tennessee and UnitedHealthcare list James Mcloughlin as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is James Mcloughlin affiliated with any hospitals?

According to CMS data, James Mcloughlin is affiliated with University Health System, Inc.

When was this NPI record last updated?

The NPPES record for James Mcloughlin was last updated on April 4, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.