Logan Spencer McCarthy, APRN
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · New Tazewell, TN
NPI 1508200437 · NPPES record last updated Jul 31, 2019
Key facts
- NPI
- 1508200437
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 0000017553 (TN)
- Practice address
- 424 N Broad St
New Tazewell, TN 37825-6606 - Phone
- (423) 869-7193
- NPI assigned
- Apr 22, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Lincoln Memorial University Medical Department, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Ridgeview Psychiatric Hospital and Center, Inc.
Practice addresses (Care Compare)
240 W Tyrone Rd
Oak Ridge, TN 37830-6517
Phone (865) 482-2003
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161212000817 | TN | Practitioner - Nurse Practitioner | 4385957067 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000017553 | TN | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Ridge Medical Management Corporation | Current | Accepting new patients | |
| Blue Ridge Medical Management Corporation | Current |
Accepting new patients | |
| Ridgeview Psychiatric Hospital and Center, Inc. | Current |
Accepting new patients | |
| Blue Ridge Medical Management Corporation | Current |
Accepting new patients |
Locations
1497 W Elk Ave
Ste 20
Elizabethton, TN 37643
Phone (423) 547-7380
403 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-7042
2 Professional Park Dr
Ste 15
Johnson City, TN 37604
Phone (423) 232-4867
240 W Tyrone Rd
Oak Ridge, TN 37830
Phone (865) 482-1076
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 76170 | KS | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 0000017553 | TN | Yes |
Addresses
Primary practice location
424 N Broad St
New Tazewell, TN 37825-6606
Mailing address
PO Box 367
Harrogate, TN 37752-0367
Phone (423) 869-7193
Other practice location 1
403 N State Of Franklin Rd
Johnson City, TN 37604-6034
Phone (423) 431-7047
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q025860 | Medicaid | TN |
Other providers in New Tazewell, TN
- Karla Madrigal Gray
- Donna Bull Malone
- Shelley Marie Martin
- Shari Lynn Mason
- Lisa Ann Mayes
- Margaret McFarland
- Diane Michelle McKinney
- Shianne Sumer Milbourn
- Andrea Brooke Miracle
- Max L Money
All providers in New Tazewell, TN · Psychiatric/Mental Health Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2019. 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.