Individual provider Active NPI

Jason S Nicholson, FNP

  • Family Nurse Practitioner
  • Johnson City, TN
National Provider Identifier
1790237394
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
21978 Issued in TN
Practice address
301 Med Tech Pkwy Ste 120
Johnson City, TN 37604-2364
Phone
(423) 794-5590
Fax
(423) 794-5877
NPI assigned
Oct 30, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 21978 TN Primary

Addresses

Primary practice location

301 Med Tech Pkwy Ste 120
Johnson City, TN 37604-2364

Mailing address

PO Box 632476
Cincinnati, OH 45263-2476
Phone (423) 794-5590

Other practice location 1

2151 Century Lane
Johnson City, TN 37604-4469
Phone (423) 926-2500

Other identifiers 1

IdentifierTypeStateIssuer
Q026470MedicaidTN

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171128001507 TN Practitioner - Nurse Practitioner 8325305428 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
State of Franklin Healthcare Associates, PLLCGroup PAC ID 2466346291, 258 clinicians

Practice addresses (Care Compare)

301 Med Tech Pkwy
Johnson City, TN 37604-2364
Phone (423) 794-5500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
21978TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
East Tennessee State University CurrentSince Aug 6, 2017 Accepting new patients
East Tennessee State University CurrentSince Aug 6, 2017 Accepting new patients
State of Franklin Healthcare Associates PLLC CurrentSince Dec 3, 2023 Accepting new patients
State of Franklin Healthcare Associates PLLC CurrentSince Nov 7, 2018 Accepting new patients

Locations

301 Med Tech Pkwy
Johnson City, TN 37604
Phone (423) 302-6239

301 Med Tech Pkwy
Ste 120
Johnson City, TN 37604
Phone (423) 794-5590

2151 Century Ln
Johnson City, TN 37604
Phone (423) 439-4071

313 Princeton Rd
Ste 3
Johnson City, TN 37601
Phone (423) 282-4819

1901 S Shady St
Mountain City, TN 37683
Phone (423) 727-1100

2700 Main St
Sneedville, TN 37869
Phone (423) 733-2819

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24871/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1477785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1790237394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 632476",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452632476",
            "telephone_number": "423-794-5590",
            "fax_number": "423-794-5877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MED TECH PKWY STE 120",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042364",
            "telephone_number": "423-794-5590",
            "fax_number": "423-794-5877"
        }
    ],
    "practiceLocations": [
        {
            "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": "NICHOLSON",
        "first_name": "JASON",
        "middle_name": "S",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-30",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "21978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q026470",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.