Mary Russell McCormick, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD48521 Issued in TN

Practice address

3019 Peoples St # Condo300
Johnson City, TN 37604-1977

Phone

(423) 461-2100

Fax

(423) 461-2199

NPI assigned

Jul 30, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

East Tennessee State University Quillen College of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Holston Medical Group PCGroup PAC ID 8224935754, 239 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Johnson City Medical Center Hospital, Johnson City, TN, CCN 440063

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: marymccormick@hmgpath.allscriptsdirect.net
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• FHIR API: https://fhir.holstonmedicalgroup.com/R4/open-R4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Holston Medical Group PC

  • Family Medicine Physician
  • Kingsport, TN
  • NPI 1831110667
  Medicare reassignment Care Compare group NPD
• Holston Medical Group, PC

  • Sports Medicine (Internal Medicine) Physician
  • Johnson City, TN
  • NPI 1205554664
  NPD
• Holston Medical Group, PC

  • Durable Medical Equipment & Medical Supplies
  • Kingsport, TN
  • NPI 1073869442
  NPD (past)

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

• Mountain States Health Alliance

  • Psychiatric Hospital Unit
  • Johnson City, TN
  • NPI 1023434339
  Care Compare affiliation
• Mountain States Health Alliance

  • Psychiatric Hospital Unit
  • Johnson City, TN
  • NPI 1962915652
  Care Compare affiliation
• Mountain States Health Alliance

  • General Acute Care Hospital
  • Johnson City, TN
  • NPI 1972606465
  Care Compare affiliation

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

{
    "created_epoch": "1248912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1568693133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376620009",
            "telephone_number": "423-857-2093",
            "fax_number": "423-390-3340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3019 PEOPLES ST # CONDO300",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376041977",
            "telephone_number": "423-461-2100",
            "fax_number": "423-461-2199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 W Stone Dr Ste 3A",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376603365",
            "country_code": "US",
            "telephone_number": "423-392-6200",
            "fax_number": "423-392-6593",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "MARY",
        "middle_name": "RUSSELL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-30",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD48521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew James McConnell, CRNA
• Peggy M. McConnell, GNP
• William Christopher McConnell, NP
• Emily Anne McCord-Dennis, MD
• Kayla Brooke McCord, OTR/L
• Taylor McCormick
• Lisa Ann McCoy
• Sarah McCray, LCSW
• Katelyn Ann McCreight, PSYD
• Beth Anna McCurley, MD

• Family Medicine Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.