NPIMap

Organization Active NPI

Mountain States Health Alliance

Doing business as Johnson City Medical Center, Regional Cancer Center

  • Clinical Social Worker
  • Johnson City, TN
National Provider Identifier
1649578386
Registry record updated Mar 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MOUNTAIN STATES HEALTH ALLIANCE
Doing business as
Johnson City Medical Center, Regional Cancer Center
Practice address
1 Professional Park Dr
Suite 21 Room C-17
Johnson City, TN 37604-6587
Phone
(423) 232-6900
Fax
(423) 232-6903
NPI assigned
Mar 4, 2011
Last updated
Mar 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2011

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

Authorized official

Name
Graciela Pereira
Title
Avp
Phone
(423) 431-7060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

1 Professional Park Dr
Suite 21 Room C-17
Johnson City, TN 37604-6587

Mailing address

1 Professional Park Dr
Suite 21 Room C-17
Johnson City, TN 37604-6587
Phone (423) 232-6900

Other names 1

  • Johnson City Medical Center, Regional Cancer Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040415001070 TN Part B Supplier - Clinic/Group Practice 6002726718 Receives reassigned benefits from 18 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Johnson City, TN; Mountain City, TN

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mountain States Health Alliance41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

Organizations that report the same tax identification number in the National Provider Directory.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1299196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299196800000",
    "number": "1649578386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PROFESSIONAL PARK DR",
            "address_2": "SUITE 21 ROOM C-17",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046587",
            "telephone_number": "423-232-6900",
            "fax_number": "423-232-6903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PROFESSIONAL PARK DR",
            "address_2": "SUITE 21 ROOM C-17",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046587",
            "telephone_number": "423-232-6900",
            "fax_number": "423-232-6903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATES HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-04",
        "last_updated": "2011-03-04",
        "status": "A",
        "authorized_official_last_name": "PEREIRA",
        "authorized_official_first_name": "GRACIELA",
        "authorized_official_title_or_position": "AVP",
        "authorized_official_telephone_number": "423-431-7060"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Johnson City Medical Center, Regional Cancer Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.