NPIMap

Individual provider Active NPI

Henry Renick Hartsoe, DO

  • Family Medicine Physician
  • Mountain City, TN
National Provider Identifier
1609455880
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5715 Issued in TN
Practice address
1901 S Shady St
Mountain City, TN 37683-2021
Phone
(423) 727-1100
NPI assigned
Apr 6, 2021
Last updated
Aug 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NA VA
Family Medicine Physician 207Q00000X 5715 TN Primary

Addresses

Primary practice location

1901 S Shady St
Mountain City, TN 37683-2021

Mailing address

1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 302-6565

Other practice location 1

295 Wharton Ln NE
Norton, VA 24273-1541
Phone (276) 679-0321

Other identifiers 1

IdentifierTypeStateIssuer
113764317OtherTNDRIVER LICENSE NUMBER

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
I20240812001882 TN Practitioner - Family Practice 0941748743 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lincoln Memorial University Medical Department, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain States Health AllianceGroup PAC ID 6002726718, 23 clinicians
Abode Care Partners LTC VB LLCGroup PAC ID 8325316516, 81 clinicians

Practice addresses (Care Compare)

1901 S Shady St
Mountain City, TN 37683-2021
Phone (423) 727-1103

919 Medical Park Dr
Mountain City, TN 37683-1042
Phone (423) 727-7800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5715TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain States Health Alliance Family Medicine CurrentSince Aug 1, 2024 Accepting new patients
Mountain States Health Alliance Family Medicine CurrentSince Aug 1, 2024 Accepting new patients
Abode Care Partners Al VB, LLC CurrentSince Nov 26, 2024 Accepting new patients
Abode Care Partners Al VB, LLC CurrentSince Nov 26, 2024 Accepting new patients
SHC Medical Partners of Tennessee, LLC CurrentSince Dec 1, 2024 Accepting new patients
Abode Care Partners LTC VB, LLC CurrentSince Nov 26, 2024 Accepting new patients
Abode Care Partners LTC VB, LLC CurrentSince Nov 26, 2024 Accepting new patients
LP Mountain City LLC Past Accepting new patients
Mountain States Health Alliance Family Medicine Past Accepting new patients

Locations

4400 Bayou Blvd
Ste 54A
Pensacola, FL 32503
Phone (727) 323-3611

12201 Bluegrass Pkwy
Louisville, KY 40299
Phone (502) 568-7364

805 N Whittington Pkwy
Ste 400
Louisville, KY 40222
Phone (502) 272-3438

805 N Whittington Pkwy
Northfield, KY 40222
Phone (502) 627-7000

1901 S Shady St
Mountain City, TN 37683
Phone (423) 727-1100

919 Medical Park Dr
Mountain City, TN 37683
Phone (423) 727-7800

415 Cole Dr
Pigeon Forge, TN 37863
Phone (865) 428-5454

Organizations & group practices 9

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 12

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": "1617667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1609455880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-302-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S SHADY ST",
            "city": "MOUNTAIN CITY",
            "state": "TN",
            "postal_code": "376832021",
            "telephone_number": "423-727-1100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "295 Wharton Ln NE",
            "address_purpose": "LOCATION",
            "city": "Norton",
            "state": "VA",
            "postal_code": "242731541",
            "country_code": "US",
            "telephone_number": "276-679-0321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARTSOE",
        "first_name": "HENRY",
        "middle_name": "RENICK",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-06",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "NA",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "5715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER LICENSE NUMBER",
            "identifier": "113764317",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain City, TN

Sources for this page

Verify at the official NPI Registry.