Individual provider Active NPI

Rachel Margret Clingensmith, PHD

  • Clinical Psychologist
  • Johnson City, TN
National Provider Identifier
1780349340
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
4061 Issued in TN
Practice address
917 W Walnut St
Johnson City, TN 37604-6527
Phone
(423) 439-6464
Fax
(423) 439-7118
NPI assigned
Nov 8, 2021
Last updated
Sep 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 4061 TN Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

917 W Walnut St
Johnson City, TN 37604-6527

Mailing address

938 Naomi Dr
Maryville, TN 37804-5254
Phone (423) 268-7012

Other practice location 1

102 E Ravine Rd
Kingsport, TN 37660-3814
Phone (423) 245-9600

Other practice location 2

325 N State Of Franklin Rd
Johnson City, TN 37604-6056
Phone (423) 439-7320

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
I20241122000335 TN Practitioner - Clinical Psychologist 6002341435 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

917 W Walnut St
Johnson City, TN 37604-6527
Phone (423) 439-6464

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Education Assistance Corporation CurrentSince Aug 30, 2024 Accepting new patients
Medical Education Assistance Corporation PastSince Jul 1, 2023 Accepting new patients

Locations

325 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 439-7280

400 E State of Franklin Rd
Johnson City, TN 37601
Phone (423) 433-6200

917 W Walnut St
Johnson City, TN 37604
Phone (423) 439-6464

102 E Ravine Rd
Kingsport, TN 37660
Phone (423) 245-9600

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1636329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1780349340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "938 NAOMI DR",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045254",
            "telephone_number": "423-268-7012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 W WALNUT ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046527",
            "telephone_number": "423-439-6464",
            "fax_number": "423-439-7118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102 E Ravine Rd",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376603814",
            "country_code": "US",
            "telephone_number": "423-245-9600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 N State Of Franklin Rd",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046056",
            "country_code": "US",
            "telephone_number": "423-439-7320",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLINGENSMITH",
        "first_name": "RACHEL",
        "middle_name": "MARGRET",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-08",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "4061",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.