NPIMap

Individual provider Active NPI

Brandon D Ketron, DO

  • Internal Medicine Physician
  • Johnson City, TN
National Provider Identifier
1558629907
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2765 Issued in TN
Practice address
301 Med Tech Pkwy
Johnson City, TN 37604-2630
Phone
(423) 794-5520
Fax
(423) 282-6940
NPI assigned
Apr 23, 2012
Last updated
Feb 19, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0102204175 VA
Internal Medicine Physician 207R00000X 2765 TN Primary

Addresses

Primary practice location

301 Med Tech Pkwy
Johnson City, TN 37604-2630

Mailing address

PO Box 632476
Cincinnati, OH 45263-2476
Phone (423) 794-5520

Other identifiers 3

IdentifierTypeStateIssuer
1558629907MedicaidNC
Q014987MedicaidTN
1558629907MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150911001876 VA Practitioner - Internal Medicine 1850616129 Reassigns benefits to 1 organization
I20150922002146 TN Practitioner - Internal Medicine 1850616129 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Lincoln Memorial University Medical Department, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of Franklin Healthcare Associates, PLLCGroup PAC ID 2466346291, 258 clinicians

Practice addresses (Care Compare)

301 Med Tech Pkwy
Johnson City, TN 37604-2364
Phone (423) 794-5500

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
State of Franklin Healthcare Associates PLLC Internal Medicine CurrentSince Jan 1, 2020 Accepting new patients
Blue Ridge Medical Management Corporation Internal Medicine CurrentSince Aug 24, 2015 Accepting new patients
Blue Ridge Medical Management Corporation Current Accepting new patients

Locations

215 E Springbrook Dr
Johnson City, TN 37601
Phone (423) 530-7900

301 Med Tech Pkwy
Johnson City, TN 37604
Phone (423) 794-5500

301 Med Tech Pkwy
Ste 240
Johnson City, TN 37604
Phone (423) 794-5520

313 Princeton Rd
Ste 3
Johnson City, TN 37601
Phone (423) 282-4819

2000 Brookside Dr
Fl 3
Kingsport, TN 37660
Phone (423) 857-5905

444 Clinchfield St
Ste 201
Kingsport, TN 37660
Phone (423) 230-2100

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24871/brand/1/csg/1/fhir/r4

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1558629907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 632476",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452632476",
            "telephone_number": "423-794-5520",
            "fax_number": "423-282-6940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MED TECH PKWY",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042630",
            "telephone_number": "423-794-5520",
            "fax_number": "423-282-6940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETRON",
        "first_name": "BRANDON",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-23",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0102204175",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "2765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558629907",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q014987",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558629907",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.