Individual provider Active NPI

Tander Lee Simberloff, MD

  • Internal Medicine Physician
  • Johnson City, TN
National Provider Identifier
1083243083
Registry record updated Nov 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
CMD19197 Issued in RI
Practice address
3 Professional Park Dr Ste 31
Johnson City, TN 37604-6529
Phone
(423) 424-3570
Fax
(423) 631-0544
NPI assigned
Apr 2, 2020
Last updated
Nov 28, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 71817 TN
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X 71817 TN
Internal Medicine Physician 207R00000X CMD19197 RI Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

3 Professional Park Dr Ste 31
Johnson City, TN 37604-6529

Mailing address

3 Professional Park Dr Ste 31
Johnson City, TN 37604-6529
Phone (423) 434-3570

Other practice location 1

400 N State Of Franklin Rd
Johnson City, TN 37604-6035
Phone (423) 431-6111

Other practice location 2

4 Sheridan Sq Ste 200
Kingsport, TN 37660-7435
Phone (423) 246-7931

Other practice location 3

2202 N John B Dennis Hwy Ste 110
Kingsport, TN 37660-5904
Phone (423) 578-8400

Other practice location 4

1 Medical Park Blvd Ste 210E
Bristol, TN 37620-7468
Phone (423) 844-5500

Other practice location 5

325 N State Of Franklin Rd Fl 2
Johnson City, TN 37604-6092
Phone (423) 433-6757

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
I20241125002206 TN Practitioner - Internal Medicine 9830519909 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
East Tennessee State University Quillen College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
WPS Providers IncGroup PAC ID 7719079532, 83 clinicians

Practice addresses (Care Compare)

3 Professional Park Dr
Suite 31
Johnson City, TN 37604-6529
Phone (423) 434-3570

325 N State of Franklin Rd
FL 2
Johnson City, TN 37604-6092
Phone (423) 439-7280

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.76 of 100Reported as apm
Quality
83.09
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CMD19197RIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Education Assistance Corporation Internal Medicine CurrentSince Oct 23, 2024 Accepting new patients
WPS Providers Inc CurrentSince Oct 21, 2024 Accepting new patients
Medical Education Assistance Corporation Internal Medicine PastSince Oct 23, 2024 Accepting new patients

Locations

1 Medical Park Blvd
Ste 210E
Bristol, TN 37620
Phone (423) 224-4000

3 Professional Park Dr
Ste 31
Johnson City, TN 37604
Phone (423) 232-6900

400 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-1310

1021 W Oakland Ave
Ste 310
Johnson City, TN 37604
Phone (423) 302-6565

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

325 N State of Franklin Rd
Fl 2
Johnson City, TN 37604
Phone (423) 439-7280

2202 N John B Dennis Hwy
Ste 110
Kingsport, TN 37660
Phone (423) 578-8400

4 Sheridan Sq
Ste 200
Kingsport, TN 37660
Phone (423) 246-7931

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732752000000",
    "number": "1083243083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 PROFESSIONAL PARK DR STE 31",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046529",
            "telephone_number": "423-434-3570",
            "fax_number": "423-631-0544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 PROFESSIONAL PARK DR STE 31",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046529",
            "telephone_number": "423-424-3570",
            "fax_number": "423-631-0544"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 N State Of Franklin Rd",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046035",
            "country_code": "US",
            "telephone_number": "423-431-6111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4 Sheridan Sq Ste 200",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376607435",
            "country_code": "US",
            "telephone_number": "423-246-7931",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2202 N John B Dennis Hwy Ste 110",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376605904",
            "country_code": "US",
            "telephone_number": "423-578-8400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Park Blvd Ste 210E",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376207468",
            "country_code": "US",
            "telephone_number": "423-844-5500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 N State Of Franklin Rd Fl 2",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046092",
            "country_code": "US",
            "telephone_number": "423-433-6757",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMBERLOFF",
        "first_name": "TANDER",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-02",
        "last_updated": "2024-11-28",
        "certification_date": "2024-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "71817",
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "TN",
            "license": "71817",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "CMD19197",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.