Vitaly Gennadievich Nazarov, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2017038349 Issued in MO

Practice address

130 W Ravine Rd
Kingsport, TN 37660-3837

Phone

(423) 224-3628

Fax

(423) 230-8502

NPI assigned

Dec 28, 2005

Last updated

Nov 21, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Vitaly Nazarov Other name

Medicare fee-for-service enrollment

Enrolled in TN, VA, SC, KY, MO5 enrollments

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.

Enrollment records 5

Specialty

Internal Medicine

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Self Medical GroupGroup PAC ID 6002953916, 393 clinicians

Tusculum Physician Services PCGroup PAC ID 7719476415, 35 clinicians

Blue Ridge Medical Management CorporationGroup PAC ID 9739099441, 283 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ballad Health Homecare Home health agency, Greeneville, TN, CCN 447428
• Greeneville Community Hospital Hospital, Greeneville, TN, CCN 440050
• Self Regional Healthcare Hospital, Greenwood, SC, CCN 420071

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: vnazarov189227@selfregional.direct-ci.net

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.

• Blue Ridge Medical Management Corporation

  dba First Assist Urgent Care

  • Urgent Care Clinic/Center
  • Elizabethton, TN
  • NPI 1144380833
  Medicare reassignment Care Compare group NPD
• Tusculum Physician Services PC

  • Hospitalist Physician
  • Greeneville, TN
  • NPI 1013895192

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Self Medical Group

  • Surgery Physician
  • Greenwood, SC
  • NPI 1982836847
  Medicare reassignment Care Compare group NPD
• Baptist Memorial Medical Group Inc

  • Internal Medicine Physician
  • Memphis, TN
  • NPI 1306089206
  Medicare reassignment NPD
• Southeastern Physician Services PC

  • Hospitalist Physician
  • Oak Ridge, TN
  • NPI 1083835441

  Internal Medicine, KY

  Medicare reassignment NPD
• Summit Medical Group, PLLC

  dba Cool Springs Internal Medicine and Pediatrics

  • Internal Medicine Physician
  • Brentwood, TN
  • NPI 1659090298
  Medicare reassignment NPD
• Wellmont Medical Associates Inc

  dba Ballad Health Medical Associates

  • Pulmonary Disease Physician
  • Bristol, TN
  • NPI 1780986257

  Internal Medicine

  Medicare reassignment NPD
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Cardiovascular Disease Physician
  • Marion, VA
  • NPI 1326159567
  Medicare reassignment NPD
• Cole Physician Services LLC

  • Hospitalist Physician
  • Jefferson City, MO
  • NPI 1144578659
  Medicare reassignment NPD
• Lake Spring Physician Services, LLC

  • Hospitalist Physician
  • Salem, VA
  • NPI 1568954287
  Medicare reassignment NPD
• Southeastern Hospitalist Services PC

  • Hospitalist Physician
  • Myrtle Beach, SC
  • NPI 1003280108

  Internal Medicine

  Medicare reassignment NPD
• Hospital Physician Services - Southeast Professional Corporation

  • Hospitalist Physician
  • Monroe, GA
  • NPI 1760410385

  SC

  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mountain States Health Alliance

  dba Ballad Health Homecare

  • Home Health Agency
  • Greeneville, TN
  • NPI 1396717963
  Care Compare affiliation
• Takoma Regional Hospital Inc

  dba Ballad Health Medical Associates

  • General Acute Care Hospital
  • Greeneville, TN
  • NPI 1699819003
  Care Compare affiliation
• Self Regional Healthcare

  dba Pain Management Greenwood

  • Pain Medicine (Anesthesiology) Physician
  • Greenwood, SC
  • NPI 1013867498

  Hospital

  Care Compare affiliation
• Self Regional Healthcare

  dba SRH - Inpatient Services

  • General Acute Care Hospital
  • Greenwood, SC
  • NPI 1023046612
  Care Compare affiliation
• Self Regional Healthcare

  dba SRH - Outpatient Services

  • General Acute Care Hospital
  • Greenwood, SC
  • NPI 1407887003
  Care Compare affiliation
• Self Regional Healthcare

  dba Pain Management Laurens

  • Pain Medicine (Anesthesiology) Physician
  • Clinton, SC
  • NPI 1720938103

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763683200000",
    "number": "1760469084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W STONE DR",
            "address_2": "SUITE 6A",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603365",
            "telephone_number": "423-408-7220",
            "fax_number": "423-408-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W RAVINE RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603837",
            "telephone_number": "423-224-3628",
            "fax_number": "423-230-8502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAZAROV",
        "first_name": "VITALY",
        "middle_name": "GENNADIEVICH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-28",
        "last_updated": "2025-11-21",
        "certification_date": "2025-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "VA",
            "license": "0101254975",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TN",
            "license": "40147",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2017038349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "4122077",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEATLHCARE",
            "identifier": "TN0119",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3334533",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VITALY",
            "last_name": "NAZAROV",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• National Seating & Mobility Inc
• National Vision, Inc. (America's Best Contacts & Eyeglasses)
• Allison Michelle Nauman, O.T.R./L.
• Megan Bray Nauman, MA, AMFT
• Tanya Naumann
• Christopher Neglia, DO
• Katherine Nehemy, CRNA
• Monna J. Nelms, NP
• Terry Nelms, FNP
• Almaa Nensey

• Internal Medicine Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2025; 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.

Verify at the official NPI Registry.