NPIMap

Individual provider Active NPI

Prasad Polisetty, M.D

  • Internal Medicine Physician
  • Johnson City, TN
National Provider Identifier
1376711291
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301090287 Issued in MI
Practice address
1735 W State of Franklin Rd Ste 5
Johnson City, TN 37604-6586
Phone
(423) 646-1862
NPI assigned
Feb 13, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301090287 MI Primary

Addresses

Primary practice location

1735 W State of Franklin Rd Ste 5
Johnson City, TN 37604-6586

Mailing address

PO Box 791825
Baltimore, MD 21279-1825
Phone (248) 633-4262

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101109000688 WV Practitioner - Internal Medicine 5799970398 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2004
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

120 12TH St Ext
Princeton, WV 24740-2352
Phone (304) 487-8000

Hospital & facility affiliations

  • Raleigh General Hospital Hospital, Beckley, WV, CCN 510070
  • Princeton Community Hospital Assn Inc Hospital, Princeton, WV, CCN 510046
  • Beckley Arh Hospital Hospital, Beckley, WV, CCN 510062
  • Carilion Medical Center Hospital, Roanoke, VA, CCN 490024
  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022
  • Encompass Health Rehab Hospital of Princeton Inpatient rehabilitation facility, Princeton, WV, CCN 513026

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301090287MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prasad Polisetty MD PLLC Internal Medicine CurrentSince Aug 1, 2022 Accepting new patients
Raleigh General Hospital LLC Past Accepting new patients
Rehabilitation Hospital Corporation of America LLC Past Accepting new patients

Locations

1710 Harper Rd
Beckley, WV 25801
Phone (304) 252-0641

120 12th Street Ext
Princeton, WV 24740
Phone (304) 487-2191

Interoperability endpoints

  • Direct secure messaging: prasad.polisetty@wvafn.hcadirect.net
  • Direct secure messaging: polisetp@yourcarecommunity.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1376711291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 791825",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212791825",
            "telephone_number": "248-633-4262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1735 W STATE OF FRANKLIN RD STE 5",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046586",
            "telephone_number": "423-646-1862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLISETTY",
        "first_name": "PRASAD",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-13",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301090287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.