Individual provider Active NPI

Richard T. Kubota, MD

  • Diagnostic Radiology Physician
  • Kingsport, TN
National Provider Identifier
1437228053
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
31154 Issued in TN
Practice address
130 W Ravine Rd
Kingsport, TN 37660
Phone
(423) 968-1144
NPI assigned
Nov 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 0101035580 VA
Diagnostic Radiology Physician 2085R0202X 31154 TN Primary

Addresses

Primary practice location

130 W Ravine Rd
Kingsport, TN 37660

Mailing address

3053 W State St
Bristol, TN 37620-1720

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TN2 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
I20060419000361 VA Practitioner - Diagnostic Radiology 9234148271 Reassigns benefits to 1 organization
I20080522000598 TN Practitioner - Diagnostic Radiology 9234148271 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Chicago, Pritzker School of Medicine, 1982
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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31154TNMDFamily Nurse Practitioner

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": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1437228053",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W RAVINE RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "37660",
            "telephone_number": "423-968-1144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBOTA",
        "first_name": "RICHARD",
        "middle_name": "T.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101035580",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TN",
            "license": "31154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.