NPIMap

Organization Active NPI

Medical Education Assistance Corporation

  • Audiologist
  • Elizabethton, TN
National Provider Identifier
1760655914
Registry record updated May 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Legal business name
MEDICAL EDUCATION ASSISTANCE CORPORATION
Practice address
1000 Jason Witten Way
Elizabethton, TN 37643-2970
Phone
(423) 439-4355
Fax
(423) 439-4607
NPI assigned
Apr 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2019

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

Authorized official

Name
Russell E. Lewis
Title
Executive Director
Phone
(423) 433-6050

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231H00000X Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

1000 Jason Witten Way
Elizabethton, TN 37643-2970

Mailing address

PO Box 699
Mountain Home, TN 37684-0699
Phone (423) 433-6039

Other identifiers 1

IdentifierTypeStateIssuer
3714470MedicaidTN

Other names 1

  • ETSU Nave Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031212000403 TN Part B Supplier - Clinic/Group Practice 2769394774 Receives reassigned benefits from 44 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Johnson City, TN; Sneedville, TN

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Univ Phy Prac Group27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556668800000",
    "number": "1760655914",
    "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": "423-433-6039",
            "fax_number": "423-433-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 JASON WITTEN WAY",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432970",
            "telephone_number": "423-439-4355",
            "fax_number": "423-439-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL EDUCATION ASSISTANCE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-09",
        "last_updated": "2019-05-01",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "423-433-6050"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3714470",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETSU Nave Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ETSU Nave Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elizabethton, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2019; 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.