Individual provider Active NPI

Michael K Patrick, M.D.

  • Internal Medicine Physician
  • Marion, VA
National Provider Identifier
1538109038
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101221326 Issued in VA
Practice address
245 Medical Park Dr FL 2
Marion, VA 24354-1100
Phone
(276) 378-2026
NPI assigned
Jun 7, 2006
Last updated
Sep 28, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 52231 TN
Hospitalist Physician 208M00000X 0101221326 VA
Hospitalist Physician 208M00000X 52231 TN
Internal Medicine Physician 207R00000X 0101221326 VA Primary

Addresses

Primary practice location

245 Medical Park Dr FL 2
Marion, VA 24354-1100

Mailing address

509 Med Tech Pkwy Ste 100
Johnson City, TN 37604-2579
Phone (423) 302-6567

Other practice location 1

1 Medical Park Blvd Ste 255W
Bristol, TN 37620-7430
Phone (423) 844-5560

Other practice location 2

1990 Holton Ave E
Big Stone Gap, VA 24219-3350
Phone (276) 523-3111

Other identifiers 4

IdentifierTypeStateIssuer
1538109038MedicaidVA
5645718OtherVAAETNA
Q002846MedicaidTN
P01250891OtherVARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Blue Ridge Medical Management Corporation PastSince Oct 2, 2022 Accepting new patients
Carilion Healthcare Corporation Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1538109038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 MED TECH PKWY STE 100",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042579",
            "telephone_number": "423-302-6567",
            "fax_number": "423-408-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 MEDICAL PARK DR FL 2",
            "city": "MARION",
            "state": "VA",
            "postal_code": "243541100",
            "telephone_number": "276-378-2026"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Park Blvd Ste 255W",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376207430",
            "country_code": "US",
            "telephone_number": "423-844-5560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1990 Holton Ave E",
            "address_purpose": "LOCATION",
            "city": "Big Stone Gap",
            "state": "VA",
            "postal_code": "242193350",
            "country_code": "US",
            "telephone_number": "276-523-3111",
            "fax_number": "276-523-8876",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "MICHAEL",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "52231",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "VA",
            "license": "0101221326",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TN",
            "license": "52231",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101221326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538109038",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5645718",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q002846",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01250891",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.