NPIMap

Individual provider Active NPI

Mark Wan Soo Chang, MD

  • Interventional Cardiology Physician
  • Johnson City, TN
National Provider Identifier
1174632475
Registry record updated Dec 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
28931 Issued in TN
Practice address
2428 Knob Creek Road
Johnson City, TN 37604
Phone
(423) 282-5054
Fax
(423) 230-5097
NPI assigned
Aug 30, 2006
Last updated
Dec 3, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2014

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 28931 TN
Cardiovascular Disease Physician 207RC0000X 0101059203 VA
Interventional Cardiology Physician 207RI0011X 28931 TN Primary
Interventional Cardiology Physician 207RI0011X 0101059203 VA

Addresses

Primary practice location

2428 Knob Creek Road
Johnson City, TN 37604

Mailing address

105 W Stone Dr
Suite 6a
Kingsport, TN 37660-3365
Phone (423) 408-7220

Other identifiers 8

IdentifierTypeStateIssuer
4017298OtherTNBCBS
89014ATMedicaidNC
005867967OtherVAMEDICAID OF VA
790596VMedicaidNC
3373123MedicaidTN
TN0102OtherTNJDH
320332OtherVAANTHEM
64001084MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110201000287 TN Practitioner - Cardiovascular Disease (Cardiology) 9234027095 Reassigns benefits to 2 organizations
I20121115000579 VA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9234027095 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Columbia University College of Physicians and Surgeons, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellmont Cardiology ServicesGroup PAC ID 5799970281, 137 clinicians

Practice addresses (Care Compare)

127 Health Care Dr
Pennington Gap, VA 24277-2853
Phone (423) 230-5000

1901 S Shady St
Suite 1
Mountain City, TN 37683-2021
Phone (423) 727-6674

1990 Holton Ave E
Big Stone Gap, VA 24219-3350
Phone (276) 523-3111

2050 Meadowview Pkwy
Kingsport, TN 37660-7475
Phone (423) 230-5000

2428 Knob Creek Rd
Suite 201
Johnson City, TN 37604-2396
Phone (423) 282-5054

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

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting28

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28931TNMDCardiovascular Disease Physician
0101059203VAMDCardiovascular Disease Physician
18400NCMDPsychiatric Hospital

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmont Medical Associates Inc CurrentSince Sep 1, 2019 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Sep 1, 2019 Accepting new patients
Wellmont Cardiology Services Cardiovascular Disease CurrentSince Oct 24, 2011 Accepting new patients
Wellmont Medical Associates Inc CurrentSince Sep 1, 2019 Accepting new patients
Wellmont Medical Associates, Inc. PastSince Sep 1, 2019 Accepting new patients
Wellmont Health System Past Accepting new patients
Wellmont Physician Services Inc Cardiovascular Disease Past Accepting new patients
Watauga Eye Center, PA Past Accepting new patients
Blue Ridge Medical Management Corporation Cardiovascular Disease Past Accepting new patients
Blue Ridge Medical Management Corporation Past Accepting new patients

Locations

105 W Stone Dr
Ste 6A
Kingsport, TN 37660
Phone (423) 408-7220

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

2050 Meadowview Pkwy
Kingsport, TN 37660

391 Falls Dr NW
Abingdon, VA 24210
Phone (276) 628-4406

1990 Holton Ave E
Big Stone Gap, VA 24219
Phone (276) 523-3111

743 Island Rd
Bristol, VA 24201
Phone (276) 469-4200

127 Health Care Dr
Ste 3
Pennington Gap, VA 24277
Phone (276) 299-5000

Organizations & group practices 10

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 7

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417564800000",
    "number": "1174632475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W STONE DR",
            "address_2": "SUITE 6A",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603365",
            "telephone_number": "423-408-7220",
            "fax_number": "423-408-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2428 KNOB CREEK ROAD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-282-5054",
            "fax_number": "423-230-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "MARK",
        "middle_name": "WAN SOO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2014-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TN",
            "license": "28931",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "VA",
            "license": "0101059203",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "TN",
            "license": "28931",
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "VA",
            "license": "0101059203",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4017298",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89014AT",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID OF VA",
            "identifier": "005867967",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790596V",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3373123",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JDH",
            "identifier": "TN0102",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "320332",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64001084",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.