Individual provider Active NPI

Victoria Paige Mingo

  • Clinical Social Worker
  • Johnson City, TN
National Provider Identifier
1740934249
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
7585 Issued in TN
Practice address
2151 Century LN
Johnson City, TN 37604-4469
Phone
(423) 926-2500
Fax
(423) 926-5999
NPI assigned
Feb 4, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 7585 TN Primary

Addresses

Primary practice location

2151 Century LN
Johnson City, TN 37604-4469

Mailing address

PO Box 70403
Johnson City, TN 37614-1703

Other practice location 1

202 W Fairview Ave
Johnson City, TN 37604-5611
Phone (423) 439-7371

Other practice location 2

807 University Pkwy
Nicks Hall, Room 160
Johnson City, TN 37614-6504
Phone (423) 439-4225

Other names 1

  • Victoria P Ryans Former name

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220221000648 TN Practitioner - Clinical Social Worker 2567856347 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Tennessee State UniversityGroup PAC ID 2769394774, 21 clinicians

Practice addresses (Care Compare)

202 W Fairview Ave
Johnson City, TN 37604-5611
Phone (423) 439-7371

2151 Century LN
Johnson City, TN 37604-4469
Phone (423) 926-2500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7585TNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
East Tennessee State University CurrentSince Feb 14, 2022 Accepting new patients
East Tennessee State University CurrentSince Feb 14, 2022 Accepting new patients
East Tennessee State University Past Accepting new patients

Locations

2151 Century Ln
Johnson City, TN 37604
Phone (423) 439-4071

202 W Fairview Ave
Johnson City, TN 37604
Phone (423) 439-7371

2700 Main St
Sneedville, TN 37869
Phone (423) 733-2819

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1643932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1740934249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70403",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376141703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 CENTURY LN",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044469",
            "telephone_number": "423-926-2500",
            "fax_number": "423-926-5999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "202 W Fairview Ave",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376045611",
            "country_code": "US",
            "telephone_number": "423-439-7371",
            "fax_number": "423-232-0420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "807 University Pkwy",
            "address_2": "Nicks Hall, Room 160",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376146504",
            "country_code": "US",
            "telephone_number": "423-439-4225",
            "fax_number": "423-439-4560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MINGO",
        "first_name": "VICTORIA",
        "middle_name": "PAIGE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-04",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "7585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICTORIA",
            "last_name": "RYANS",
            "middle_name": "P",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.