Paul B Landry III, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1603 Issued in TN

Practice address

310 N State of Franklin Rd
Suite 101
Johnson City, TN 37604-6008

Phone

(423) 929-7393

Fax

(423) 929-0872

NPI assigned

Jun 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in TN, IA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Iowa Mercy ClinicsGroup PAC ID 7810809076, 304 clinicians

Wellmont Cardiology ServicesGroup PAC ID 5799970281, 137 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Johnson City Medical Center Hospital, Johnson City, TN, CCN 440063
• Franklin Woods Community Hospital Hospital, Johnson City, TN, CCN 440184
• Greeneville Community Hospital Hospital, Greeneville, TN, CCN 440050

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Wellmont Cardiology Services

  • Cardiovascular Disease Physician
  • Kingsport, TN
  • NPI 1376575035
  Medicare reassignment Care Compare group
• North Iowa Mercy Clinics

  • Anesthesiology Physician
  • Mason City, IA
  • NPI 1780278242
  Medicare reassignment Care Compare group
• Blue Ridge Medical Management Corporation

  • Urgent Care Clinic/Center
  • Elizabethton, TN
  • NPI 1144380833
  Medicare reassignment
• Blue Ridge Medical Management Corporation

  • Internal Medicine Physician
  • Erwin, TN
  • NPI 1538989371
  NPD
• Blue Ridge Medical Management Corporation

  • Family Medicine Physician
  • Johnson City, TN
  • NPI 1982553756
  NPD
• North Iowa Mercy Clinics

  • Cardiovascular Disease Physician
  • Mason City, IA
  • NPI 1801147269

  Physician Assistant

  NPD
• North Iowa Mercy Clinics

  • Family Medicine Physician
  • Forest City, IA
  • NPI 1811003015
  NPD
• North Iowa Mercy Clinics

  • Sports Medicine (Family Medicine) Physician
  • Mason City, IA
  • NPI 1982300349
  NPD
• Norwood Surgical Specialists, LLC

  • Surgery Physician
  • Shreveport, LA
  • NPI 1790836781
  NPD (past)

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

• Mountain States Health Alliance

  • Psychiatric Hospital Unit
  • Johnson City, TN
  • NPI 1023434339
  Care Compare affiliation
• Mountain States Health Alliance

  • General Acute Care Hospital
  • Johnson City, TN
  • NPI 1114033628
  Care Compare affiliation
• Mountain States Health Alliance

  • Psychiatric Hospital Unit
  • Johnson City, TN
  • NPI 1962915652
  Care Compare affiliation
• Mountain States Health Alliance

  • General Acute Care Hospital
  • Johnson City, TN
  • NPI 1972606465
  Care Compare affiliation
• Takoma Regional Hospital Inc

  • General Acute Care Hospital
  • Greeneville, TN
  • NPI 1699819003
  Care Compare affiliation

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487116800000",
    "number": "1477599892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 N STATE OF FRANKLIN RD",
            "address_2": "SUITE 101",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046008",
            "telephone_number": "423-929-7393",
            "fax_number": "423-929-0872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 N STATE OF FRANKLIN RD",
            "address_2": "SUITE 101",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046008",
            "telephone_number": "423-929-7393",
            "fax_number": "423-929-0872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDRY",
        "first_name": "PAUL",
        "middle_name": "B",
        "name_suffix": "III",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2017-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "1603",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "1603",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477599892",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1506078",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "TN01 UW",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "4190518",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100095460",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00686005",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle W Lamb, PT
• Mary Erney Lamoy, BA
• Jennifer Lancaster, LCSW, Q-SAP
• Ryan M Landis, MD
• Alicia B Landry, PA-C
• Amber Lane, RN
• Beth Bailey Lane
• Beulah Lane, RN
• Bryce Alexander Lane
• Elizabeth A Lane, R.D.

• Physician Assistant in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.