NPIMap

Individual provider Active NPI

Megan D Johnson

  • Family Medicine Physician
  • Elizabethton, TN
National Provider Identifier
1457644254
Registry record updated Feb 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
51290 Issued in TN
Practice address
1497 W Elk Ave
Suite 21
Elizabethton, TN 37643-2895
Phone
(423) 542-7420
Fax
(423) 542-7425
NPI assigned
May 26, 2011
Last updated
Feb 10, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 10, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 51290 TN Primary

Addresses

Primary practice location

1497 W Elk Ave
Suite 21
Elizabethton, TN 37643-2895

Mailing address

1497 W Elk Ave
Suite 21
Elizabethton, TN 37643-2895
Phone (423) 542-7420

Other identifiers 3

IdentifierTypeStateIssuer
1457644254MedicaidVA
6023539OtherTNBLUECARE
Q008037MedicaidTN

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
I20141115000312 TN Practitioner - Family Practice 0345462941 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Champion Physical Therapy LLC HallsGroup PAC ID 1355416306, shared by 4 NPIs, 277 clinicians

Practice addresses (Care Compare)

1497 W Elk Ave
Elizabethton, TN 37643-2896

420 Railroad St
Elizabethton, TN 37643-2504
Phone (423) 297-1813

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
51290TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain States Health Alliance Family Medicine CurrentSince Aug 1, 2023 Accepting new patients
Mountain States Health Alliance Family Medicine Current Accepting new patients
Mountain States Health Alliance CurrentSince Aug 1, 2023 Accepting new patients
Blue Ridge Medical Management Corporation Family Medicine CurrentSince Sep 1, 2014 Accepting new patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Blue Ridge Medical Management Corporation Past Accepting new patients

Locations

1497 W Elk Ave
Ste 21
Elizabethton, TN 37643
Phone (423) 542-7420

1497 W Elk Ave
Ste 20
Elizabethton, TN 37643
Phone (423) 547-7380

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

1019 W Oakland Ave
Ste 1
Johnson City, TN 37604
Phone (423) 915-5000

1901 S Shady St
Mountain City, TN 37683
Phone (423) 727-1100

Organizations & group practices 6

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.

Hospital & facility affiliations 5

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": "1306368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486684800000",
    "number": "1457644254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1497 W ELK AVE",
            "address_2": "SUITE 21",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432895",
            "telephone_number": "423-542-7420",
            "fax_number": "423-542-7425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1497 W ELK AVE",
            "address_2": "SUITE 21",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432895",
            "telephone_number": "423-542-7420",
            "fax_number": "423-542-7425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MEGAN",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-26",
        "last_updated": "2017-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "51290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457644254",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECARE",
            "identifier": "6023539",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q008037",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethton, TN

Sources for this page

Verify at the official NPI Registry.