Individual provider Active NPI

Priya Narayanan Jain, M.D.

  • Pediatrics Physician
  • Johnson City, TN
National Provider Identifier
1053555433
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
62574 Issued in TN
Practice address
325 N. State of Franklin Road
Ground FL
Johnson City, TN 37604
Phone
(423) 439-7320
NPI assigned
Apr 29, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A126025 CA
Pediatrics Physician 208000000X 283696 NY
Pediatrics Physician 208000000X 62574 TN Primary

Addresses

Primary practice location

325 N. State of Franklin Road
Ground FL
Johnson City, TN 37604

Mailing address

PO Box 699
Mountain Home, TN 37684-0699

Other practice location 1

1505 W Elk Ave Ste 1
Elizabethton, TN 37643-2848
Phone (423) 543-7919

Other identifiers 1

IdentifierTypeStateIssuer
Q066396MedicaidTN

Other names 1

  • Mrs. Priya Jain Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20210713001359 TN Practitioner - Pediatric Medicine 8325299910 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
283696NYMDPediatrics Physician
62574TNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Education Assistance Corporation Pediatrics CurrentSince Aug 1, 2021 Accepting new patients

Locations

1505 W Elk Ave
Ste 1
Elizabethton, TN 37643
Phone (423) 543-7919

325 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 439-7280

400 E State of Franklin Rd
Johnson City, TN 37601
Phone (423) 433-6200

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1240963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1053555433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376840699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N. STATE OF FRANKLIN ROAD",
            "address_2": "GROUND FL",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-439-7320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1505 W Elk Ave Ste 1",
            "address_purpose": "LOCATION",
            "city": "Elizabethton",
            "state": "TN",
            "postal_code": "376432848",
            "country_code": "US",
            "telephone_number": "423-543-7919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAIN",
        "first_name": "PRIYA",
        "middle_name": "NARAYANAN",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-29",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A126025",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "283696",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "62574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q066396",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PRIYA",
            "last_name": "JAIN",
            "prefix": "MRS.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.