Active NPI
Paul Thomas Provance, M.D.
- Internal Medicine Physician
- Mountain Home, TN
National Provider Identifier
1760429740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD41434
- Practice address
- James H Quillen VA Medical Center
Mountain Home, TN 37684-4000 - Phone
- (423) 926-1171
- NPI assigned
- May 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 35.086268 | OH | |
| Internal Medicine Physician | 207R00000X | MD41434 | TN | Primary |
Addresses
Primary practice location
James H Quillen VA Medical Center
Mountain Home, TN 37684-4000
Mailing address
PO Box 4000
Mountain Home, TN 37684-4000
Phone (423) 926-1171
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3825653 | Medicaid | TN | |
| 2571293 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN, VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Wright State University Boonshoft School of Medicine, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
105 W Stone Dr
Suite 3a
Kingsport, TN 37660-3256
Phone (423) 392-6200
1754 US Hwy 23 N
Weber City, VA 24290-7071
Phone (276) 386-9771
4862 Dickenson Hwy
Clintwood, VA 24228-1810
Hospital & facility affiliations
- Amedisys Home Health Care
- Wellmont Holston Valley Medical Center
- Indian Path Community Hospital
- Johnson City Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.086268 | OH | MD | Internal Medicine Physician |
| MD41434 | TN | MD | Internal Medicine Physician |
| 41434 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holston Medical Group, PC | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- https://fhir.holstonmedicalgroup.com/R4/open-R4
- paulprovance@hmgpath.allscriptsdirect.net
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.
-
- Physical Therapist
- Clintwood, VA
- NPI 1871513788
-
- Durable Medical Equipment & Medical Supplies
- Kingsport, TN
- NPI 1073869442
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Psychiatric Hospital Unit
- Johnson City, TN
- NPI 1023434339
-
- Psychiatric Hospital Unit
- Johnson City, TN
- NPI 1962915652
-
- General Acute Care Hospital
- Johnson City, TN
- NPI 1972606465
-
- General Acute Care Hospital
- Kingsport, TN
- NPI 1992813240
-
- General Acute Care Hospital
- Kingsport, TN
- NPI 1487690400
-
- Home Health Agency
- Abingdon, VA
- NPI 1225096886
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289174400000",
"number": "1760429740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4000",
"city": "MOUNTAIN HOME",
"state": "TN",
"postal_code": "376844000",
"telephone_number": "423-926-1171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "JAMES H QUILLEN VA MEDICAL CENTER",
"city": "MOUNTAIN HOME",
"state": "TN",
"postal_code": "376844000",
"telephone_number": "423-926-1171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVANCE",
"first_name": "PAUL",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-31",
"last_updated": "2010-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OH",
"license": "35.086268",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "TN",
"license": "MD41434",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3825653",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2571293",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mountain Home, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.