Individual provider Active NPI

Jody Eric Musick, PT

  • Physical Therapist
  • Kingsport, TN
National Provider Identifier
1174826424
Registry record updated Jan 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6591 Issued in TN
Practice address
110 E Center St
Kingsport, TN 37660-4230
Phone
(423) 765-1611
Fax
(423) 765-1612
NPI assigned
Dec 8, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6591 TN Primary

Addresses

Primary practice location

110 E Center St
Kingsport, TN 37660-4230

Mailing address

406 Roy Martin Rd
Suite 9
Gray, TN 37615-2244
Phone (423) 477-1101

Other identifiers 3

IdentifierTypeStateIssuer
4293094OtherTNBLUE CROSS BLUE SHIELD TN
4293094MedicaidTN
Q004105MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110316000720 TN Practitioner - Physical Therapist in Private Practice 2961684691 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Achieve Health and WellnessGroup PAC ID 2567644289, 5 clinicians

Practice addresses (Care Compare)

110 E Ctr St
Kingsport, TN 37660-4230
Phone (423) 765-1611

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6591TNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Achieve Health and Wellness Physical Therapist CurrentSince Jan 17, 2011 Accepting new patients
Achieve Health and Wellness PastSince Jan 17, 2011 Accepting new patients
Achieve Bracing PastSince Mar 1, 2013 Accepting new patients
Highlander Family Medicine PLLC Past Accepting new patients
Woodstock Rehab & Fitness Physical Therapist PastSince Sep 6, 2016 Accepting new patients

Locations

406 Roy Martin Rd
Ste 9
Johnson City, TN 37615
Phone (423) 477-1101

110 E Center St
Kingsport, TN 37660
Phone (423) 477-1101

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1291766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579132800000",
    "number": "1174826424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 ROY MARTIN RD",
            "address_2": "SUITE 9",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376152244",
            "telephone_number": "423-477-1101",
            "fax_number": "423-477-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E CENTER ST",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604230",
            "telephone_number": "423-765-1611",
            "fax_number": "423-765-1612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSICK",
        "first_name": "JODY",
        "middle_name": "ERIC",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-12-08",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "6591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD TN",
            "identifier": "4293094",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4293094",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q004105",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jan 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.