Individual provider Active NPI

Kaushal Yogeshbhai Shah, MD

  • Psychiatry Physician
  • Bristol, VA
National Provider Identifier
1275858516
Registry record updated Apr 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
0101255976 Issued in VA
Practice address
103 North St Ste a
Bristol, VA 24201-3201
Phone
(276) 642-7901
NPI assigned
Mar 30, 2010
Last updated
Apr 10, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 53610 TN
Psychiatry Physician 2084P0800X 0101255976 VA Primary

Addresses

Primary practice location

103 North St Ste a
Bristol, VA 24201-3201

Mailing address

1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 952-2111

Other practice location 1

1 Medical Park Blvd Fl 5
Bristol, TN 37620-7430
Phone (423) 844-1121

Other practice location 2

2000 Brookside Dr
Kingsport, TN 37660-4627
Phone (423) 857-7000

Other practice location 3

403 N State Of Franklin Rd
Johnson City, TN 37604-6034
Phone (423) 431-7111

Other practice location 4

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 224-4000

Other practice location 5

Corner of Lamont & Veterans Way
Mountain Home VA Medical Center
Mountain Home, TN 37684
Phone (423) 926-1171 ext. 7753

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151215000189 VA Practitioner - Psychiatry 5092016188 Reassigns benefits to 1 organization
I20160125001366 TN Practitioner - Psychiatry 5092016188 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53610TNMDPsychiatry Physician
0101255976VAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Wellmont Medical Associates Inc CurrentSince Nov 1, 2015 Accepting new patients
Wellmont Medical Associates, Inc. Psychiatry CurrentSince Nov 1, 2015 Accepting new patients
Blue Ridge Medical Management Corporation Psychiatry CurrentSince Apr 9, 2021 Accepting new patients
Wellmont Medical Associates Inc CurrentSince Dec 12, 2015 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Apr 9, 2021 Accepting new patients

Locations

1 Medical Park Blvd
Fl 5
Bristol, TN 37620
Phone (423) 844-1121

1497 W Elk Ave
Ste 20
Elizabethton, TN 37643
Phone (423) 547-7380

1019 W Oakland Ave
Ste 1
Johnson City, TN 37604
Phone (423) 915-5000

1021 W Oakland Ave
Ste 310
Johnson City, TN 37604
Phone (423) 302-6565

403 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-7042

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

130 W Ravine Rd
Kingsport, TN 37660
Phone (423) 224-3150

2000 Brookside Dr
Kingsport, TN 37660
Phone (423) 857-7144

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

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

103 North St
#A
Bristol, VA 24201
Phone (423) 844-5300

103 North St
Ste A
Bristol, VA 24201
Phone (276) 642-7901

Organizations & group practices 6

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": "1269907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775779200000",
    "number": "1275858516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-952-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 NORTH ST STE A",
            "city": "BRISTOL",
            "state": "VA",
            "postal_code": "242013201",
            "telephone_number": "276-642-7901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Park Blvd Fl 5",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376207430",
            "country_code": "US",
            "telephone_number": "423-844-1121",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2000 Brookside Dr",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376604627",
            "country_code": "US",
            "telephone_number": "423-857-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "403 N State Of Franklin Rd",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046034",
            "country_code": "US",
            "telephone_number": "423-431-7111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 W Ravine Rd",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376603837",
            "country_code": "US",
            "telephone_number": "423-224-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Corner of Lamont & Veterans Way",
            "address_2": "Mountain Home VA Medical Center",
            "address_purpose": "LOCATION",
            "city": "Mountain Home",
            "state": "TN",
            "postal_code": "37684",
            "country_code": "US",
            "telephone_number": "423-926-1171 x7753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "KAUSHAL",
        "middle_name": "YOGESHBHAI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-30",
        "last_updated": "2026-04-10",
        "certification_date": "2026-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "53610",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0101255976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, VA

Sources for this page

Verify at the official NPI Registry.