Charla Barefield Bacon, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

22937 Issued in TN

Practice address

1018 Chase Dr
Johnson City, TN 37604-1402

Phone

(423) 282-3379

Fax

(423) 430-6227

NPI assigned

Sep 5, 2017

Last updated

Mar 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jason Della Vecchia MD PLLCGroup PAC ID 1658808811, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Jason Della Vecchia MD PLLC

  dba Fresh Start Medicine

  • Addiction Medicine (Internal Medicine) Physician
  • Kingsport, TN
  • NPI 1053191866
  Medicare reassignment Care Compare group NPD
• Emmaus Medical and Counseling, PLLC

  • Addiction Medicine (Internal Medicine) Physician
  • Bulls Gap, TN
  • NPI 1598256117

  VA

  Medicare reassignment NPD
• Scott County Drug

  • Community/Retail Pharmacy
  • Weber City, VA
  • NPI 1538235296
  NPD (past)

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

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1639697188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1018 CHASE DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376041402",
            "telephone_number": "423-282-3379",
            "fax_number": "423-430-6227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1018 CHASE DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376041402",
            "telephone_number": "423-282-3379",
            "fax_number": "423-430-6227"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "926 W Oakland Ave Ste 206",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376041445",
            "country_code": "US",
            "telephone_number": "423-282-3379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BACON",
        "first_name": "CHARLA",
        "middle_name": "BAREFIELD",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-05",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "22937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Borzou Azima, MD
• Back to Health P.C. (Back to Health Chiropractic and Wellnes)
• James Steven Backers, PHARM D
• Joanne E Backofen, M.D.
• Casey E. Bacon, M.S. CCC-SLP
• Kimberly S Bacon, NP
• Paul Ryan Bader, PA
• Kristina Bagley
• Mona Mylene Baharestani, PHD, APN, CWOCN, CWS
• Anne Bailey, R.P.H

• Family Nurse Practitioner in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; 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.