Active NPI
Tammy R. Moody, LCSW
- Clinical Social Worker
- Johnson City, TN
National Provider Identifier
1528132016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LSW 876
- Practice address
- 332 E Springbrook Dr
Suite 500
Johnson City, TN 37601-1767 - Phone
- (423) 282-1394
- Fax
- (423) 282-1394
- NPI assigned
- Nov 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LSW 876 | TN | Primary |
Addresses
Primary practice location
332 E Springbrook Dr
Suite 500
Johnson City, TN 37601-1767
Mailing address
332 E Springbrook Dr
Suite 500
Johnson City, TN 37601-1767
Phone (423) 282-1394
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4094498 | Other | TN | BLUE CROSS BLUE SHIELD |
| 3927687 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2023 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LSW 876 | TN | MD | Clinical Social Worker |
| 876 | TN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210377600000",
"number": "1528132016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "332 E SPRINGBROOK DR",
"address_2": "SUITE 500",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376011767",
"telephone_number": "423-282-1394",
"fax_number": "423-282-1394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "332 E SPRINGBROOK DR",
"address_2": "SUITE 500",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376011767",
"telephone_number": "423-282-1394",
"fax_number": "423-282-1394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOODY",
"first_name": "TAMMY",
"middle_name": "R.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-17",
"last_updated": "2008-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TN",
"license": "LSW 876",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "4094498",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3927687",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.