NPIMap

Individual provider Active NPI

Bethany Conly

  • Obstetrics & Gynecology Physician
  • Kingsport, TN
National Provider Identifier
1700129525
Registry record updated Dec 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
68928 Issued in TN
Practice address
105 W Park Dr
Kingsport, TN 37660
Phone
(423) 224-3220
NPI assigned
Mar 29, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 68928 TN Primary

Addresses

Primary practice location

105 W Park Dr
Kingsport, TN 37660

Mailing address

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

Other practice location 1

378 Marketplace Blvd Ste 5
Johnson City, TN 37604
Phone (423) 282-0751

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170711001462 CA Practitioner - Obstetrics/Gynecology 8022303288 Reassigns benefits to 1 organization
I20231027001184 TN Practitioner - Obstetrics/Gynecology 8022303288 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of California, Irvine, California College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellmont Medical Associates IncGroup PAC ID 8123291739, 432 clinicians

Practice addresses (Care Compare)

105 W Park Dr
Kingsport, TN 37660-3805
Phone (423) 224-3220

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmont Medical Associates, Inc. CurrentSince Oct 29, 2023 Accepting new patients
Svmhs Clinics CurrentSince Jul 1, 2017 Accepting new patients
Wellmont Health System Current Accepting new patients
Svmhs Clinics CurrentSince Jul 1, 2017 Accepting new patients
Wellmont Medical Associates Inc Obstetrics & Gynecology CurrentSince Oct 29, 2023 Accepting new patients
Solstas Lab Partners Group LLC Past Accepting new patients
Lancelot O Alexander MD a Medical Corporation Past Accepting new patients
Wellmont Medical Associates Inc Past Accepting new patients
Wellmont Medical Associates, Inc. PastSince Oct 29, 2023 Accepting new patients

Locations

100 Wilson Rd
Ste 100
Monterey, CA 93940
Phone (831) 242-8301

250 San Jose St
Salinas, CA 93901
Phone (831) 758-8223

1033 Los Palos Dr
Salinas, CA 93901
Phone (831) 424-2866

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

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

105 W Park Dr
Kingsport, TN 37660
Phone (423) 224-3220

Interoperability endpoints

  • Direct secure messaging: bconly411299@balladhealth.medalliesdirect.net

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1364515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702857600000",
    "number": "1700129525",
    "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": "105 W PARK DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "37660",
            "telephone_number": "423-224-3220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "378 Marketplace Blvd Ste 5",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "37604",
            "country_code": "US",
            "telephone_number": "423-282-0751",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONLY",
        "first_name": "BETHANY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-29",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TN",
            "license": "68928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.