Individual provider Active NPI

Adam Seth Penley, PA

  • Physician Assistant
  • Johnson City, TN
National Provider Identifier
1689402141
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1503 Woodland Ave
Johnson City, TN 37601-2635
Phone
(423) 220-6897
NPI assigned
Jul 24, 2024
Last updated
Jul 24, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

1503 Woodland Ave
Johnson City, TN 37601-2635

Mailing address

1503 Woodland Ave
Johnson City, TN 37601-2635
Phone (423) 220-6897

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241115003448 TN Practitioner - Physician Assistant 9830623636 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Watauga Orthopaedics PLCGroup PAC ID 1456246479, 85 clinicians

Practice addresses (Care Compare)

1132 Erwin Hwy
Greeneville, TN 37745-4405
Phone (423) 282-9011

2410 Susannah St
Johnson City, TN 37601-1748
Phone (423) 282-9011

340 Steeles Rd
Bristol, TN 37620-9532
Phone (423) 282-9011

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
6142TNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Watauga Orthopaedics PLC Physician Assistant CurrentSince Sep 1, 2024 Accepting new patients
Watauga Orthopaedics, PLC Physician Assistant CurrentSince Sep 1, 2024 Accepting new patients

Locations

2410 Susannah St
Johnson City, TN 37601
Phone (423) 282-9011

Interoperability endpoints

  • Direct secure messaging: adam.penley.1@3374.direct.athenahealth.com

Organizations & group practices 2

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 1

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": "1721779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1689402141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 WOODLAND AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012635",
            "telephone_number": "423-220-6897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 WOODLAND AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012635",
            "telephone_number": "423-220-6897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENLEY",
        "first_name": "ADAM",
        "middle_name": "SETH",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-24",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.