Ray Wallace Mettetal Jr., M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

MD 10753 Issued in TN

Practice address

303 E 11TH Ave
Johnson City, TN 37601-3932

Phone

(423) 341-7538

NPI assigned

Jul 7, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 22, 2018 through Jan 22, 2028

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Ray W. Mettetal Jr., M.D. Inc.

  • Medical Specialty Clinic/Center
  • Johnson City, TN
  • NPI 1043451578
  Authorized official Same address or phone
• Charlottesville Neurology and Sleep Medicine PC

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • Charlottesville, VA
  • NPI 1972577070
  NPD (past)

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

{
    "created_epoch": "1183766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730387036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E 11TH AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376013932",
            "telephone_number": "423-341-7538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 E 11TH AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376013932",
            "telephone_number": "423-341-7538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "METTETAL",
        "first_name": "RAY",
        "middle_name": "WALLACE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TN",
            "license": "MD 10753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "086382",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Messiah Transportation
• Samuel F Messimer, DC
• Lindsay Messinger, M.D.
• Jill Metcalf, M.S, CCC-SLP
• Basundhara Mete, MBBS
• Kevin Allen Metzger, D.O.
• Frances Nicole Meyer, BSW
• Karen Meyer
• Mary L Michal, M.D.
• Microbac Healthcare Services, LLC

• Neurology Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Neurology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.