Active NPI
Homayoun Modarresifar, MD
- Nuclear Imaging & Therapy Physician
- Johnson City, TN
National Provider Identifier
1235146648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nuclear Imaging & Therapy Physician
- License
- MD0000046850
- Practice address
- 2109 W Market St Ste 122
Etsu, Innovation Laboratory
Johnson City, TN 37604-6024 - Phone
- (423) 439-8000
- NPI assigned
- Aug 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nuclear Medicine Physician | 207U00000X | 41198 | AZ | |
| Nuclear Imaging & Therapy Physician | 207UN0902X | A93513 | CA | |
| Nuclear Imaging & Therapy Physician | 207UN0902X | N5255 | TX | |
| Nuclear Imaging & Therapy Physician | 207UN0902X | MD0000046850 | TN | Primary |
Addresses
Primary practice location
2109 W Market St Ste 122
Etsu, Innovation Laboratory
Johnson City, TN 37604-6024
Mailing address
2109 W Market St Ste 122
Etsu, Innovation Laboratory
Johnson City, TN 37604-6024
Phone (423) 439-8000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD0000046850 | Other | TN | TENNESSEE MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD0000046850 | TN | MD | Nuclear Imaging & Therapy Physician |
| N5255 | TX | MD | Nuclear Imaging & Therapy Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305244800000",
"number": "1235146648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2109 W MARKET ST STE 122",
"address_2": "ETSU, INNOVATION LABORATORY",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376046024",
"telephone_number": "423-439-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2109 W MARKET ST STE 122",
"address_2": "ETSU, INNOVATION LABORATORY",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376046024",
"telephone_number": "423-439-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODARRESIFAR",
"first_name": "HOMAYOUN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2011-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "207U00000X",
"taxonomy_group": "",
"desc": "Nuclear Medicine",
"state": "AZ",
"license": "41198",
"primary": false
},
{
"code": "207UN0902X",
"taxonomy_group": "",
"desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
"state": "CA",
"license": "A93513",
"primary": false
},
{
"code": "207UN0902X",
"taxonomy_group": "",
"desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
"state": "TX",
"license": "N5255",
"primary": false
},
{
"code": "207UN0902X",
"taxonomy_group": "",
"desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
"state": "TN",
"license": "MD0000046850",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TENNESSEE MEDICAL LICENSE",
"identifier": "MD0000046850",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.