Amanda Davis Ingram, MD
Individual provider Active NPI Diagnostic Radiology Physician · Kingsport, TN
NPI 1497901854 · NPPES record last updated Oct 26, 2018
Key facts
- NPI
- 1497901854
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 49584 (TN)
- Practice address
- 103 W Stone Dr
Kingsport, TN 37660 - Phone
- (423) 968-1144
- NPI assigned
- Aug 15, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- University of Tennessee, HSC, College of Medicine, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Blue Ridge Radiology PC
Practice addresses (Care Compare)
1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 844-2200
103 W Stone Dr
Kingsport, TN 37660-3220
Phone (423) 244-6800
130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 244-6800
Hospital & facility affiliations
- Wellmont Holston Valley Medical Center
- Indian Path Community Hospital
- Johnson City Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130621000551 | TN | Practitioner - Diagnostic Radiology | 5496911679 | Reassigns benefits to 1 organization |
| I20130916000489 | VA | Practitioner - Diagnostic Radiology | 5496911679 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101253972 | VA | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Ridge Radiology, P.C. | Diagnostic Radiology | Current |
Accepting new patients |
Locations
3053 W State St
Bristol, TN 37620
Phone (423) 301-6567
1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451
4289 Bonny Oaks Dr
Ste 106
Chattanooga, TN 37406
103 W Stone Dr
Kingsport, TN 37660
Phone (423) 224-4050
130 W Ravine Rd
Kingsport, TN 37660
Phone (423) 224-3150
851 Locust St
Rogersville, TN 37857
Phone (423) 272-2671
127 Health Care Dr
Pennington Gap, VA 24277
Phone (276) 299-5000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 49584 | TN | Yes |
| Diagnostic Radiology Physician | 2085R0202X | 35098925 | OH |
Addresses
Primary practice location
103 W Stone Dr
Kingsport, TN 37660
Mailing address
3053 W State St
Bristol, TN 37620-1720
Other practice location 1
1924 Alcoa Hwy
Knoxville, TN 37920-1511
Phone (865) 305-9661
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q001537 | Medicaid | TN |
Other providers in Kingsport, TN
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All providers in Kingsport, TN · Diagnostic Radiology Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.