Individual provider Active NPI

Craig Wassinger, PT

  • Physical Therapist
  • Kingsport, TN
National Provider Identifier
1235357963
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8787 Issued in TN
Practice address
102 E Ravine Rd
Kingsport, TN 37660-3814
Phone
(423) 245-9600
NPI assigned
Apr 20, 2007
Last updated
Mar 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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 8787 TN Primary

Addresses

Primary practice location

102 E Ravine Rd
Kingsport, TN 37660-3814

Mailing address

PO Box 699
Mountain Home, TN 37684-0699

Other practice location 1

1043 Jack Vest Dr
Johnson City, TN 37614
Phone (423) 439-4044

Other identifiers 1

IdentifierTypeStateIssuer
Q066021MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210715003479 TN Practitioner - Physical Therapist in Private Practice 4587066352 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

102 E Ravine Rd
Kingsport, TN 37660-3814
Phone (423) 245-9600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8787TNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Education Assistance Corporation CurrentSince Sep 1, 2021 Accepting new patients
Medical Education Assistance Corporation PastSince Sep 1, 2021 Accepting new patients

Locations

400 E State of Franklin Rd
Johnson City, TN 37601
Phone (423) 433-6200

102 E Ravine Rd
Kingsport, TN 37660
Phone (423) 245-9600

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1235357963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376840699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E RAVINE RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603814",
            "telephone_number": "423-245-9600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1043 Jack Vest Dr",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "37614",
            "country_code": "US",
            "telephone_number": "423-439-4044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WASSINGER",
        "first_name": "CRAIG",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2024-03-01",
        "certification_date": "2024-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "8787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q066021",
            "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 Mar 1, 2024; 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.