Jake Sides

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

63286 Issued in TN

Practice address

1 Medical Park Blvd Ste 250W
Bristol, TN 37620-7431

Phone

(423) 844-6620

Fax

(423) 844-6626

NPI assigned

Mar 31, 2016

Last updated

Jul 3, 2024By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

General Surgery

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

WPS Providers IncGroup PAC ID 7719079532, 83 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellmont Bristol Regional Medical Center Hospital, Bristol, TN, CCN 440012
• Smyth County Community Hospital Hospital, Marion, VA, CCN 490038
• Johnston Memorial Hospital Hospital, Abingdon, VA, CCN 490053
• Russell County Hospital Hospital, Lebanon, VA, CCN 490002

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• KY PPO
• TN PPO C-SNP
• KY PPO C-SNP
• TN PPO
• devoted network organization-92131eb0-09f2-4173-a140-cf7b381f0cf1

Interoperability endpoints

• Direct secure messaging: jsides@bsa.gwaydirect.com

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.

• WPS Providers Inc

  • General Practice Physician
  • Kingsport, TN
  • NPI 1003904095

  Multi-Specialty, VA

  Medicare reassignment Care Compare group NPD
• Bristol Surgical Associates PC

  • Surgery Physician
  • Bristol, TN
  • NPI 1811066947

  Multi-Specialty

  Medicare reassignment NPD
• Wellmont Medical Associates Inc

  dba Ballad Health Medical Associates

  • Pulmonary Disease Physician
  • Bristol, TN
  • NPI 1780986257

  Multi-Specialty

  Medicare reassignment NPD
• Wellmont Medical Associates, Inc.

  dba Ballad Health Medical Associates

  • Psychiatry Physician
  • Johnson City, TN
  • NPI 1275393522

  Multi-Specialty

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Wellmont Health System

  dba Bristol Regional Medical Center

  • General Acute Care Hospital
  • Bristol, TN
  • NPI 1124058615
  Care Compare affiliation
• Johnston Memorial Hospital, Inc

  • General Acute Care Hospital
  • Abingdon, VA
  • NPI 1104812684
  Care Compare affiliation
• Mountain States Health Alliance

  dba Russell County Hospital

  • General Acute Care Hospital
  • Lebanon, VA
  • NPI 1891973939
  Care Compare affiliation
• Smyth County Community Hospital

  • General Acute Care Hospital
  • Marion, VA
  • NPI 1073519377
  Care Compare affiliation
• Smyth County Community Hospital

  dba Center for Sleep Disorders at SCCH

  • General Acute Care Hospital
  • Marion, VA
  • NPI 1194104687
  Care Compare affiliation
• Smyth County Community Hospital

  • Durable Medical Equipment & Medical Supplies
  • Marion, VA
  • NPI 1750433389

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1003279662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-302-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK BLVD STE 250W",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207431",
            "telephone_number": "423-844-6620",
            "fax_number": "423-844-6626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "594 Radio Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "VA",
            "postal_code": "243544224",
            "country_code": "US",
            "telephone_number": "423-844-6620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIDES",
        "first_name": "JAKE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-31",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101275797",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "63286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madeline Grace Shipley
• William Chris Shipley, D. D. S.
• Nancy S Shisler, C.F.N.P.
• Amy Nicole Shortt, ACNP-AG
• William R Shumaker, O.D.
• Samuel Sim, MD
• Kelly Carter Simcox, FNP-BC
• Evelyn Faye Simerly, REGISTERED NURSE
• Mara W Sindoni, MA
• Brittney Kestner Skeen

• Surgery Physician in Bristol, TN
• Providers in Bristol, TN by specialty
• Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.