Organization Active NPI

East Tennessee Medical Associates, P.C.

  • Nephrology Physician
  • Johnson City, TN
National Provider Identifier
1619089034
Registry record updated Aug 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD6775 Issued in TN
Legal business name
EAST TENNESSEE MEDICAL ASSOCIATES, P.C.
Practice address
107 Woodlawn Dr
Johnson City, TN 37604-5978
Phone
(423) 929-7158
Fax
(423) 928-9625
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2026

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

Authorized official

Name
Melissa Ann Owens
Title
Practice Manager
Phone
(423) 929-7158

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X MD6775 TN Primary

Addresses

Primary practice location

107 Woodlawn Dr
Johnson City, TN 37604-5978

Mailing address

107 Woodlawn Dr
Johnson City, TN 37604-6287
Phone (423) 929-7158

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050106000879 TN Part B Supplier - Clinic/Group Practice 2062460009 Receives reassigned benefits from 7 practitioners
Practice locations: Johnson City, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0310587East Tennessee Medical Associates107 Woodlawn Dr Ste 200, Johnson City, TN 37604Provider-performed microscopyJan 8, 2028

National Provider Directory

National Provider Directory

Locations

107 Woodlawn Dr
Ste 200Q
Johnson City, TN 37604

100 Technology Ln
Johnson City, TN 37604
Phone (423) 929-7181

107 Woodlawn Dr
Ste 200
Johnson City, TN 37604
Phone (423) 929-7158

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787270400000",
    "number": "1619089034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 WOODLAWN DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046287",
            "telephone_number": "423-929-7158",
            "fax_number": "423-928-9625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 WOODLAWN DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376045978",
            "telephone_number": "423-929-7158",
            "fax_number": "423-928-9625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE MEDICAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2026-08-21",
        "certification_date": "2026-08-21",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "423-929-7158"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "TN",
            "license": "MD6775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.