NPIMap

Organization Active NPI

Watauga Orthopaedics, PLC

  • Durable Medical Equipment & Medical Supplies
  • Kingsport, TN
National Provider Identifier
1104125210
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
WATAUGA ORTHOPAEDICS, PLC
Practice address
875 Larry Neil Way
Kingsport, TN 37601
Phone
(423) 282-9011
Fax
(423) 282-0035
NPI assigned
Mar 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Authorized official

Name
Christy Harris
Title
Billing Manager
Phone
(423) 282-9582

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X TN
Durable Medical Equipment & Medical Supplies 332B00000X
Durable Medical Equipment & Medical Supplies 332B00000X TN Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X TN

Addresses

Primary practice location

875 Larry Neil Way
Kingsport, TN 37601

Mailing address

2410 Susannah Street
Johnson City, TN 37601
Phone (423) 282-9011

Other identifiers 1

IdentifierTypeStateIssuer
3706248MedicaidTN

Other names 1

  • Watauga Orthopaedics of Kingsport Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930062408 TN DME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Sports MedicineDME Supplier - Independently-Practicing Physical Therapist 1456246479 Practice locations: Kingsport, TN

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Watauga Orthopaedics PL4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

340 Steeles Rd
Bristol, TN 37620
Phone (423) 282-9011

2412 Susannah St
Johnson City, TN 37601
Phone (423) 282-8070

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/3374/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 85

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 85

NPI Registry JSON

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

{
    "created_epoch": "1300233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719360000000",
    "number": "1104125210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 SUSANNAH STREET",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37601",
            "telephone_number": "423-282-9011",
            "fax_number": "423-282-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 LARRY NEIL WAY",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "37601",
            "telephone_number": "423-282-9011",
            "fax_number": "423-282-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATAUGA ORTHOPAEDICS, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-16",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "423-282-9582"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "TN",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3706248",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Watauga Orthopaedics of Kingsport",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Watauga Orthopaedics of Kingsport",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.