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SAMUEL W HUDDLESTON IV MD
NPI 1770508525
Surgery - Plastic and Reconstructive Surgery in Kingsport, TN

Active since July 13, 2006PECOS Enrolled
2002 BROOKSIDE DRIVE, STE 201, KINGSPORT, TN 37660(423) 245-7080(423) 245-7875 Get Directions Write a Review

NPPES record last updated: March 7, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Samuel W Huddleston Iv Md NPPES

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

SAMUEL W HUDDLESTON IV MD (NPI 1770508525) is an individual plastic and reconstructive surgery provider in Kingsport, Tennessee, licensed in Tennessee (15029) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1770508525
Entity TypeIndividualMale
Primary Taxonomy2086S0122X
Provider Legal NameSAMUEL W HUDDLESTON IVCredential: MD
Location Address2002 BROOKSIDE DRIVE, STE 201Kingsport, TN 37660
Mailing Address2002 Brookside Drive, Ste 201Kingsport, TN 37660 · (423) 245-7080 · Fax (423) 245-7875
Phone(423) 245-7080
Fax(423) 245-7875
Sole ProprietorNo
Enumeration DateJuly 13, 2006
Last NPPES UpdateMarch 7, 2023
✔ NPI 1770508525 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0122X
License✔ Licensed in TN · 15029
Definition
A surgeon who specializes in plastic and reconstructive surgery.
2002 BROOKSIDE DRIVE, Kingsport, TN 37660
Open in Google Maps ↗

Other Identifiers 5

Other384053Anthem
Other15029Lic
Other5331096Aetna
Medicaid3032417TN
Other0070707Bcbs

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel W Huddleston Iv Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignment

Medicare enrollment records show Samuel Huddleston reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Sam W. Huddleston IV MD PC
Same address
Specialist
2002 BROOKSIDE DR, SUITE# 201
Kingsport, TN 37660
  • Reassigned Medicare billing, Tennessee enrollment
NPI 1649641200 (423) 245-7080

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims

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 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.
12 services12 patients

Other Providers at the Same Location NPPES

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

REGIONAL KIDNEY CARE, PC
Specialist
2002 BROOKSIDE DRIVE, SUITE 102
KINGSPORT, TN 37660
Sullivan County (423) 245-6000

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 Samuel Huddleston's NPI number?

The NPI number for Samuel Huddleston is 1770508525. It was assigned to this individual provider in the NPPES registry on July 13, 2006.

Where is Samuel Huddleston located?

Samuel Huddleston practices at 2002 Brookside Drive Ste 201, Kingsport, TN 37660. The listed phone number is (423) 245-7080.

What is Samuel Huddleston's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Is Samuel Huddleston enrolled in Medicare?

Yes. Samuel Huddleston is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Samuel Huddleston's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Huddleston reassigns Medicare benefits to Sam W. Huddleston IV MD PC (Kingsport, TN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Samuel Huddleston's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Samuel Huddleston was last updated on March 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.