Michael Itidiare, D.O., M.B.S

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

25MB10130600 Issued in NJ

Practice address

130 W Ravine Rd
Kingsport, TN 37660-3837

Phone

(423) 224-4000

NPI assigned

Jul 16, 2013

Last updated

Feb 25, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ, MD, DC3 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 3

Specialty

Gastroenterology

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Capital Health Medical GroupGroup PAC ID 7618264532, 442 clinicians

Atlanticare Physician Group PAGroup PAC ID 8527953660, 506 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Atlanticare Regional Medical Center - City Campus Hospital, Atlantic City, NJ, CCN 310064
• Wellmont Holston Valley Medical Center Hospital, Kingsport, TN, CCN 440017
• Capital Health Medical Center - Hopewell Hospital, Pennington, NJ, CCN 310044
• Medstar Georgetown University Hospital Hospital, Washington, DC, CCN 090004

Merit-based Incentive Payment System (MIPS)

Final score

96.91 of 100Reported as apm

Quality

79.42

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12833/brand/1/csg/1/fhir/r4

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.

• Capital Health Medical Group

  • Internal Medicine Physician
  • Trenton, NJ
  • NPI 1437516887
  Medicare reassignment Care Compare group NPD
• Atlanticare Physician Group PA

  • Clinic/Center
  • Egg Harbor Township, NJ
  • NPI 1093829608
  Medicare reassignment Care Compare group
• Capital Health Multispecialty Group

  • Surgery Physician
  • Trenton, NJ
  • NPI 1083072342

  Internal Medicine

  Medicare reassignment NPD
• Medstar Medical Group II LLC

  • General Practice Physician
  • Baltimore, MD
  • NPI 1184046187

  DC

  Medicare reassignment NPD
• Wellmont Medical Associates Inc

  dba Ballad Health Medical Associates

  • Pulmonary Disease Physician
  • Bristol, TN
  • NPI 1780986257

  Internal Medicine

  NPD
• Wellmont Medical Associates, Inc.

  dba Ballad Health Medical Associates

  • Psychiatry Physician
  • Johnson City, TN
  • NPI 1275393522
  NPD
• Atlanticare Physician Group, PA

  dba AtlantiCare Urgent Care

  • Urgent Care Clinic/Center
  • Galloway, NJ
  • NPI 1003820622
  NPD
• Medstar Medical Group II LLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Washington, DC
  • NPI 1205562816
  NPD
• Medstar Medical Group II LLC

  • Internal Medicine Physician
  • Washington, DC
  • NPI 1376887844
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Wellmont Health System

  dba Holston Valley Medical Center

  • General Acute Care Hospital
  • Kingsport, TN
  • NPI 1487690400
  Care Compare affiliation
• Atlanticare Regional Medical Center

  • General Acute Care Hospital
  • Pomona, NJ
  • NPI 1013919315
  Care Compare affiliation
• Capital Health System, Inc.

  dba Capital Health Medical Center - Hopewell

  • General Acute Care Hospital
  • Pennington, NJ
  • NPI 1073516183
  Care Compare affiliation
• Medstar - Georgetown Medical Center, Inc.

  dba Georgetown University Hospital

  • General Acute Care Hospital
  • Washington, DC
  • NPI 1427145176
  Care Compare affiliation

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771977600000",
    "number": "1316388556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CAPITAL WAY",
            "city": "PENNINGTON",
            "state": "NJ",
            "postal_code": "085342520",
            "telephone_number": "609-303-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W RAVINE RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603837",
            "telephone_number": "423-224-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Capital Way",
            "address_purpose": "LOCATION",
            "city": "Pennington",
            "state": "NJ",
            "postal_code": "085342520",
            "country_code": "US",
            "telephone_number": "609-303-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Park Blvd",
            "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"
        }
    ],
    "basic": {
        "last_name": "ITIDIARE",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O., M.B.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-16",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NJ",
            "license": "25MB10130600",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "6450",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0102208235",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TN",
            "license": "6450",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "VA",
            "license": "0102208235",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jean Scott Inderfurth, CRNP
• Laken N Ingle, COTA/L
• Ingles Markets Inc (Ingles Pharmacy #072)
• Amanda Davis Ingram, MD
• Genesia Dickson Irick, FNP
• Itl Pharma
• Amanda R. Jackson, NP
• Brian Jackson
• Elizabeth Michele Jackson, M.D.
• Kelly Nicole Jackson, FNP

• Gastroenterology Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Gastroenterology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.