Individual provider Active NPI

Mitchell J. Mendrek, M.D.

  • Diagnostic Radiology Physician
  • Bristol, TN
National Provider Identifier
1386682276
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
026160 Issued in LA
Practice address
1 Medical Park Blvd
Bristol, TN 37620-7430
Phone
(423) 968-1144
Fax
(423) 968-3453
NPI assigned
Jun 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 026160 LA Primary

Addresses

Primary practice location

1 Medical Park Blvd
Bristol, TN 37620-7430

Mailing address

3053 W State St
Bristol, TN 37620-1720
Phone (423) 968-1144

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 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
I20060727000191 TN Practitioner - Diagnostic Radiology 3870506462 Reassigns benefits to 1 organization
I20201124002754 VA Practitioner - Diagnostic Radiology 3870506462 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Alabama School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blue Ridge Radiology PCGroup PAC ID 7416860473, 77 clinicians

Practice addresses (Care Compare)

1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 844-2200

105 Fairlea CT
Lynchburg, VA 24503-2164
Phone (423) 968-1144

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 244-6800

Hospital & facility affiliations

  • Wellmont Bristol Regional Medical Center Hospital, Bristol, TN, CCN 440012
  • Johnson City Medical Center Hospital, Johnson City, TN, CCN 440063
  • Wellmont Holston Valley Medical Center Hospital, Kingsport, TN, CCN 440017
  • Johnston Memorial Hospital Hospital, Abingdon, VA, CCN 490053
  • Franklin Woods Community Hospital Hospital, Johnson City, TN, CCN 440184

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
026160LAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Radiology, P.C. Diagnostic Radiology CurrentSince Aug 1, 2006 Accepting new patients

Locations

3053 W State St
Bristol, TN 37620
Phone (423) 301-6567

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

4289 Bonny Oaks Dr
Ste 106
Chattanooga, TN 37406

Organizations & group practices 1

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386682276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3053 W STATE ST",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376201720",
            "telephone_number": "423-968-1144",
            "fax_number": "423-968-3453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK BLVD",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207430",
            "telephone_number": "423-968-1144",
            "fax_number": "423-968-3453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDREK",
        "first_name": "MITCHELL",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "LA",
            "license": "026160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, TN

Sources for this page

Verify at the official NPI Registry.