Internal Medicine and Pediatric Assoc of Bristol
Organization Active NPI Internal Medicine Physician · Bristol, TN
NPI 1093760902 · NPPES record last updated May 4, 2026
Key facts
- NPI
- 1093760902
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- INTERNAL MEDICINE AND PEDIATRIC ASSOC OF BRISTOL
- Practice address
- 350 Steeles Road
Bristol, TN 37620-9532 - Phone
- (423) 844-6700
- Fax
- (423) 844-6703
- NPI assigned
- May 23, 2006
- Organization subpart
- No
Authorized official
- Name
- Vicki L Moody
- Title
- Practice Executive
- Phone
- (423) 844-6704
Practitioners 9
-
Bernard Grunstra, MD
-
Shelby Olds, MD
-
Jamie Michelle White, FNP-C
-
John Paul Blakley, FNP-C
-
Brittney O'Hara, NP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0694591 | Internal Med & Ped Assoc of Bristol PC | Provider-performed microscopy | Jul 2, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040830000125 | TN | Part B Supplier - Clinic/Group Practice | 9335114875 |
Receives reassigned benefits from 7 practitioners Practice locations: Bristol, TN |
National Provider Directory
Locations
350 Steeles Rd
Bristol, TN 37620
Phone (423) 844-4925
350 Steeles Rd
#2
Bristol, TN 37620
Phone (423) 844-6700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | TN | ||
| Internal Medicine Physician |
207R00000X | TN | Yes | |
| Pediatrics Physician |
208000000X | TN |
Addresses
Primary practice location
350 Steeles Road
Bristol, TN 37620-9532
Mailing address
350 Steeles Rd Ste 2
Bristol, TN 37620-9532
Phone (423) 844-6700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CG2912 | Other | SD | MEDICARE RAILROAD |
| 3707101 | Other | TN | TNCARE PN |
| CG2912 | Other | SD | MEDICARE RAILROAD # |
Other names
- internal medicine and pediatric associates of bristol pc
Other providers in Bristol, TN
- Independent Physical Therapy, LLC
- Jessica Ingle
- Innovative Surgical Solutions, PLLC
- Integrated Health Concepts, LLC
- Integrated Health Concepts, LLC
- Ipc Pac Healthcare Services of Tennessee PC
- Samantha R. Irwin
- Pierre Istfan
- Caytlin Sabryn James
- Sarah Jamshed
All providers in Bristol, TN · Internal Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.