NPIMap

Organization Active NPI

Wellmont Cardiology Services

  • Cardiovascular Disease Physician
  • Kingsport, TN
National Provider Identifier
1376575035
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
WELLMONT CARDIOLOGY SERVICES
Practice address
2050 Meadowview Parkway
Kingsport, TN 37660-7332
Phone
(423) 230-5000
Fax
(423) 230-5097
NPI assigned
Jul 6, 2006
Last updated
Apr 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Authorized official

Name
Juanita L Harwood
Title
Director, Ishn Network Management
Phone
(423) 302-6565

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU
Surgical Physician Assistant 363AS0400X NU
Nurse Practitioner 363L00000X NU
Acute Care Nurse Practitioner 363LA2100X NU
Adult Health Nurse Practitioner 363LA2200X NU
Family Nurse Practitioner 363LF0000X NU
Cardiovascular Disease Physician 207RC0000X NU Primary
Interventional Cardiology Physician 207RI0011X NU
Vascular Surgery Physician 2086S0129X NU
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X NU

Addresses

Primary practice location

2050 Meadowview Parkway
Kingsport, TN 37660-7332

Mailing address

2050 Meadowview Pkwy
Kingsport, TN 37660-7475
Phone (423) 230-5000

Other identifiers 5

IdentifierTypeStateIssuer
3382171MedicaidTN
DR5963OtherTNRAILROAD MEDICARE
DR8098OtherVARAILROAD MEDICARE
1376575035MedicaidVA
3382170MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101110000334 VA Part B Supplier - Clinic/Group Practice 5799970281 Receives reassigned benefits from 76 practitioners
Practice locations: Marion, VA; Wytheville, VA; Pennington Gap, VA; Norton, VA; Big Stone Gap, VA; Abingdon, VA
O20101215000083 TN Part B Supplier - Clinic/Group Practice 5799970281 Receives reassigned benefits from 138 practitioners
Practice locations: Sneedville, TN; Rogersville, TN; Elizabethton, TN; Mountain City, TN; Kingsport, TN; Johnson City, TN; Bristol, TN; Erwin, TN…

National Provider Directory

National Provider Directory

Locations

1 Medical Park Blvd
Ste 458W
Bristol, TN 37620
Phone (423) 230-6900

630 Oneega Ln
Ste B
Erwin, TN 37650
Phone (423) 230-5006

115 Judge Gresham Rd
Ste A
Gray, TN 37615
Phone (423) 467-3000

310 N State of Franklin Rd
Ste 202
Johnson City, TN 37604
Phone (423) 434-3700

2033 Meadowview Ln
Kingsport, TN 37660
Phone (423) 230-6040

2205 Pavilion Dr
Ste 105
Kingsport, TN 37660
Phone (423) 247-2252

444 Clinchfield St
Ste 2900
Kingsport, TN 37660
Phone (423) 245-6101

4485 W Stone Dr
Ste 200
Kingsport, TN 37660
Phone (423) 224-3150

16000 Johnston Memorial Dr
Ste 212
Abingdon, VA 24211
Phone (276) 258-2732

616 Campus Dr
Ste 300
Abingdon, VA 24210
Phone (276) 525-1917

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

344 Overlook Dr
Ste 200
Lebanon, VA 24266
Phone (276) 883-5900

245 Medical Park Dr
Ste 6A
Marion, VA 24354

615 Commonwealth Dr
Norton, VA 24273
Phone (276) 679-6493

590 W Ridge Rd
Ste 5
Wytheville, VA 24382
Phone (276) 228-5506

Practitioners & affiliated clinicians

Practitioners 155

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 155

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713744000000",
    "number": "1376575035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 MEADOWVIEW PKWY",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376607475",
            "telephone_number": "423-230-5000",
            "fax_number": "423-230-5035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 MEADOWVIEW PARKWAY",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376607332",
            "telephone_number": "423-230-5000",
            "fax_number": "423-230-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLMONT CARDIOLOGY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "HARWOOD",
        "authorized_official_first_name": "JUANITA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR, ISHN NETWORK MANAGEMENT",
        "authorized_official_telephone_number": "423-302-6565"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3382171",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DR5963",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DR8098",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376575035",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3382170",
            "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 Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.