Individual provider Active NPI

Robert J Detroye, MD

  • Orthopaedic Surgery Physician
  • Johnson City, TN
National Provider Identifier
1437114956
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
23453 Issued in TN
Practice address
2410 Susannah St
Johnson City, TN 37601-1748
Phone
(423) 282-9011
Fax
(423) 282-0035
NPI assigned
Apr 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 23453 TN Primary

Addresses

Primary practice location

2410 Susannah St
Johnson City, TN 37601-1748

Mailing address

2410 Susannah St
Johnson City, TN 37601-1748
Phone (423) 282-9011

Other identifiers 1

IdentifierTypeStateIssuer
3066599MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20091125000004 TN Practitioner - Orthopedic Surgery 8325140403 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Wisconsin School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Watauga Orthopaedics PLCGroup PAC ID 1456246479, 85 clinicians
Champion Physical Therapy LLC HallsGroup PAC ID 1355416306, shared by 4 NPIs, 277 clinicians

Practice addresses (Care Compare)

2410 Susannah St
Johnson City, TN 37601-1748
Phone (423) 282-9011

4307 N Roan St
Suite 7
Johnson City, TN 37615-4973
Phone (423) 491-5222

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Watauga Orthopaedics, PLC Orthopaedic Surgery CurrentSince Jan 1, 1995 Accepting new patients
Watauga Orthopaedics PLC Orthopaedic Surgery CurrentSince Jan 1, 1995 Accepting new patients

Locations

340 Steeles Rd
Bristol, TN 37620
Phone (423) 282-9011

2412 Susannah St
Johnson City, TN 37601
Phone (423) 282-8070

2410 Susannah St
Johnson City, TN 37601
Phone (423) 282-9011

875 Larry Neil Way
Kingsport, TN 37660
Phone (423) 282-9011

Interoperability endpoints

  • Direct secure messaging: robert.detroye.1@3374.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1437114956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 SUSANNAH ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011748",
            "telephone_number": "423-282-9011",
            "fax_number": "423-282-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 SUSANNAH ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011748",
            "telephone_number": "423-282-9011",
            "fax_number": "423-282-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETROYE",
        "first_name": "ROBERT",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "TN",
            "license": "23453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3066599",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.