NPIMap

Individual provider Active NPI

Brandon K Moore, DO

  • Internal Medicine Physician
  • Johnson City, TN
National Provider Identifier
1396908430
Registry record updated May 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2317 Issued in TN
Practice address
301 Med Tech Pkwy Ste 240
Johnson City, TN 37604-2641
Phone
(423) 794-5520
Fax
(423) 282-6940
NPI assigned
Jul 9, 2008
Last updated
May 2, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0102202866 VA
Internal Medicine Physician 207R00000X 2317 TN Primary

Addresses

Primary practice location

301 Med Tech Pkwy Ste 240
Johnson City, TN 37604-2641

Mailing address

215 E Springbrook Dr
Johnson City, TN 37601-1761
Phone (423) 794-5520

Other identifiers 5

IdentifierTypeStateIssuer
P01050137OtherTNRR MEDICARE
1396908430MedicaidNC
1396908430MedicaidVA
1526217MedicaidTN
7100188700MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20111123000680 TN Practitioner - Internal Medicine 0840469052 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Pikeville, Kentucky College of Osteopathic Med, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Physician Services PCGroup PAC ID 0042307852, 591 clinicians

Practice addresses (Care Compare)

1201 Bishop St
Union City, TN 38261-5403
Phone (731) 885-2410

300 Med Tech Pkwy
Johnson City, TN 37604-2277
Phone (423) 302-1000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Physician Services PC Internal Medicine CurrentSince Jun 1, 2021 Accepting new patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Wellmont Medical Associates, Inc. Internal Medicine CurrentSince Apr 1, 2019 Accepting new patients
Wellmont Medical Associates Inc Internal Medicine Current Accepting new patients
State of Franklin Healthcare Associates PLLC CurrentSince Nov 15, 2020 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Oct 15, 2011 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Oct 15, 2011 Accepting new patients
Johnston Memorial Hospital, Inc Past Accepting new patients
Mountain States Health Alliance Past Accepting new patients
Wellmont Health System Past Accepting new patients
Blue Ridge Medical Management Corporation Internal Medicine Past Accepting new patients
Wellmont Health System Past Accepting new patients
Renuven Health Partners of Georgia PC Internal Medicine Past Accepting new patients
Mountain States Health Alliance Past Accepting new patients

Locations

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

2 Professional Park Dr
Ste 15
Johnson City, TN 37604
Phone (423) 232-4867

215 E Springbrook Dr
Johnson City, TN 37601
Phone (423) 530-7900

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

130 W Ravine Rd
Ste 3A
Kingsport, TN 37660
Phone (423) 224-3220

2000 Brookside Dr
Fl 3
Kingsport, TN 37660
Phone (423) 857-5905

1201 Bishop St
Union City, TN 38261
Phone (423) 698-6061

245 North St
Bristol, VA 24201
Phone (276) 669-4711

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 9

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": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588377600000",
    "number": "1396908430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E SPRINGBROOK DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011761",
            "telephone_number": "423-794-5520",
            "fax_number": "423-282-6940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MED TECH PKWY STE 240",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042641",
            "telephone_number": "423-794-5520",
            "fax_number": "423-282-6940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "BRANDON",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-09",
        "last_updated": "2020-05-02",
        "certification_date": "2020-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0102202866",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "2317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01050137",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396908430",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396908430",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1526217",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100188700",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.