Marc A. Fagelson, PH.D., CCC-A

Primary specialty

AudiologistTaxonomy code 231H00000X

License

0000001136 Issued in TN

Practice address

156 S. Dossett Drive
Johnson City, TN 37614

Phone

(423) 439-4355

Fax

(423) 439-4607

NPI assigned

Jul 5, 2006

Sex

Male

Sole proprietor

No

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

Enrolled in TN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Medical Education Assistance Corporation

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1235180480
  Medicare reassignment NPD
• East Tennessee State University

  • Federally Qualified Health Center (FQHC)
  • Johnson City, TN
  • NPI 1477660199
  NPD (past)

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1760413116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376840699",
            "telephone_number": "423-439-4515",
            "fax_number": "423-439-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 S. DOSSETT DRIVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37614",
            "telephone_number": "423-439-4355",
            "fax_number": "423-439-4607"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "807 University Pkwy",
            "address_2": "ETSU Campus Lamb Hall Room 361",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376141702",
            "country_code": "US",
            "telephone_number": "423-439-4515",
            "fax_number": "423-439-4607",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Jason Witten Way",
            "address_purpose": "LOCATION",
            "city": "Elizabethton",
            "state": "TN",
            "postal_code": "376432970",
            "country_code": "US",
            "telephone_number": "423-439-4355",
            "fax_number": "423-543-0581",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2151 Century Lane",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376044469",
            "country_code": "US",
            "telephone_number": "423-926-2500",
            "fax_number": "423-926-5999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAGELSON",
        "first_name": "MARC",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "PH.D., CCC-A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "TN",
            "license": "0000001136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3198223",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Audiologist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Audiologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; 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.