Individual provider Active NPI

Donald Wayne Larkin, PHD

  • Clinical Psychologist
  • Johnson City, TN
National Provider Identifier
1609104462
Registry record updated Jul 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
P1278 Issued in TN
Practice address
119 Boone Ridge Dr
Suite 201
Johnson City, TN 37615-4998
Phone
(423) 282-1480
Fax
(423) 928-1353
NPI assigned
Dec 5, 2009
Last updated
Jul 24, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X P1278 TN Primary

Addresses

Primary practice location

119 Boone Ridge Dr
Suite 201
Johnson City, TN 37615-4998

Mailing address

119 Boone Ridge Dr
Suite 201
Johnson City, TN 37615-4998
Phone (423) 282-1480

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100205000211 TN Practitioner - Clinical Psychologist 0749323202 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
BH Services Southeast 1 PCGroup PAC ID 7012457054, 96 clinicians
Ipc Pac Healthcare Services of Tennessee PCGroup PAC ID 0840587572, 74 clinicians
NV Pacs 2 LLCGroup PAC ID 0941550578, 119 clinicians

Practice addresses (Care Compare)

18 N Cavalier Dr
Alamo, TN 38001-6468
Phone (731) 696-4500

505 N Roan St
Johnson City, TN 37601-4740
Phone (423) 975-2000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P1278TNMDClinical Psychologist
1278TNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Physician Services PC CurrentSince Oct 1, 2016 Accepting new patients
Ipc Pac Healthcare Services of Tennessee PC CurrentSince Oct 1, 2016 Accepting new patients
CS Pacs 3 Southeast, LLC CurrentSince Sep 11, 2024 Accepting new patients
BH Services Southeast 1 PC CurrentSince Aug 17, 2025 Accepting new patients
NV Pacs 2 LLC CurrentSince Aug 17, 2021 Accepting new patients
Wayne E. Tasker and Associates, Inc. Clinical Past Accepting new patients

Locations

18 N Cavalier Dr
Alamo, TN 38001
Phone (731) 696-4500

2305 Chambliss Ave NW
Cleveland, TN 37311
Phone (423) 559-6000

880 S Mohawk Dr
Erwin, TN 37650
Phone (423) 743-7669

725 Crum St
Greeneville, TN 37743
Phone (423) 440-8810

119 Boone Ridge Dr
Ste 201
Johnson City, TN 37615
Phone (423) 928-1145

1101 Persimmon Ridge Rd
Jonesborough, TN 37659
Phone (423) 254-0010

1201 Bishop St
Union City, TN 38261
Phone (423) 698-6061

Organizations & group practices 6

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": "1259971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437696000000",
    "number": "1609104462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 BOONE RIDGE DR",
            "address_2": "SUITE 201",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154998",
            "telephone_number": "423-282-1480",
            "fax_number": "423-928-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 BOONE RIDGE DR",
            "address_2": "SUITE 201",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154998",
            "telephone_number": "423-282-1480",
            "fax_number": "423-928-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARKIN",
        "first_name": "DONALD",
        "middle_name": "WAYNE",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-12-05",
        "last_updated": "2015-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "P1278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.