NPIMap

Organization Active NPI

Medadvance PLLC

  • Family Medicine Physician
  • Knoxville, TN
National Provider Identifier
1104634377
Registry record updated Aug 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEDADVANCE PLLC
Practice address
800 S Gay St Ste 700
Knoxville, TN 37929-9703
Phone
(440) 652-8748
Fax
(440) 582-3171
NPI assigned
Dec 20, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2026

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

Authorized official

Name
Tracy Wimberg
Title
VP Billing Operations
Phone
(609) 517-2526

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

800 S Gay St Ste 700
Knoxville, TN 37929-9703

Mailing address

731 Bay Ave
Somers Point, NJ 08244-2378

Other practice location 1

731 Bay Ave
Somers Point, NJ 08244-2378
Phone (865) 888-9958

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250429001553 TN Part B Supplier - Clinic/Group Practice 5698291078 Receives reassigned benefits from 12 practitioners
Practice locations: Knoxville, TN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1734652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787529600000",
    "number": "1104634377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 BAY AVE",
            "city": "SOMERS POINT",
            "state": "NJ",
            "postal_code": "082442378",
            "fax_number": "440-582-3171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S GAY ST STE 700",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379299703",
            "telephone_number": "440-652-8748",
            "fax_number": "440-582-3171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "731 Bay Ave",
            "address_purpose": "LOCATION",
            "city": "Somers Point",
            "state": "NJ",
            "postal_code": "082442378",
            "country_code": "US",
            "telephone_number": "865-888-9958",
            "fax_number": "440-582-3171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEDADVANCE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-20",
        "last_updated": "2026-08-24",
        "certification_date": "2026-08-24",
        "status": "A",
        "authorized_official_last_name": "WIMBERG",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "VP BILLING OPERATIONS",
        "authorized_official_telephone_number": "609-517-2526"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; 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.