NPIMap

Individual provider Active NPI

Sheryl D Pack, MD

  • Family Medicine Physician
  • Elizabethton, TN
National Provider Identifier
1598715419
Registry record updated Feb 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
33787 Issued in TN
Practice address
1497 W Elk Ave
Suite 21
Elizabethton, TN 37643-2895
Phone
(423) 542-7420
Fax
(423) 542-7425
NPI assigned
May 11, 2006
Last updated
Feb 21, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 33787 TN Primary

Addresses

Primary practice location

1497 W Elk Ave
Suite 21
Elizabethton, TN 37643-2895

Mailing address

1497 W Elk Ave
Suite 21
Elizabethton, TN 37643-2895
Phone (423) 542-7420

Other identifiers 5

IdentifierTypeStateIssuer
3864465MedicaidTN
1598715419MedicaidVA
3865561MedicaidTN
4122812OtherTNBCBST
3865567MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060224000162 TN Practitioner - Family Practice 5294741559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arizona College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1497 W Elk Ave
Suite 21
Elizabethton, TN 37643-2872
Phone (423) 542-7420

Hospital & facility affiliations

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 CurrentSince Apr 17, 2006 Accepting new patients
Blue Ridge Medical Management Corporation Family Medicine CurrentSince Apr 17, 2006 Accepting new patients
Blue Ridge Medical Management Corporation Past Accepting new patients

Locations

1497 W Elk Ave
Ste 20
Elizabethton, TN 37643
Phone (423) 547-7380

1497 W Elk Ave
Ste 21
Elizabethton, TN 37643
Phone (423) 542-7420

1505 W Elk Ave
Ste 2
Elizabethton, TN 37643
Phone (423) 543-1261

1019 W Oakland Ave
Ste 1
Johnson City, TN 37604
Phone (423) 915-5000

2 Professional Park Dr
Ste 15
Johnson City, TN 37604
Phone (423) 232-4867

Organizations & group practices 4

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 4

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487635200000",
    "number": "1598715419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1497 W ELK AVE",
            "address_2": "SUITE 21",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432895",
            "telephone_number": "423-542-7420",
            "fax_number": "423-542-7425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1497 W ELK AVE",
            "address_2": "SUITE 21",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432895",
            "telephone_number": "423-542-7420",
            "fax_number": "423-542-7425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "SHERYL",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2017-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "33787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3864465",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598715419",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3865561",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "4122812",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3865567",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethton, TN

Sources for this page

Verify at the official NPI Registry.