Individual provider Active NPI

Charisma Bailey, FNP-BC

  • Nurse Practitioner
  • Johnson City, TN
National Provider Identifier
1801200506
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
0024171841 Issued in VA
Practice address
310 N State of Franklin Rd Ste 400
Johnson City, TN 37604-6051
Phone
(423) 979-6000
NPI assigned
Jun 20, 2014
Last updated
Jun 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0024171841 VA Primary
Family Nurse Practitioner 363LF0000X 18986 TN

Addresses

Primary practice location

310 N State of Franklin Rd Ste 400
Johnson City, TN 37604-6051

Mailing address

1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 302-6565

Other practice location 1

16000 Johnston Memorial Dr
Fourth Floor
Abingdon, VA 24211-7664
Phone (276) 258-4050

Other practice location 2

378 Marketplace Blvd Ste 5
Johnson City, TN 37604-2361
Phone (423) 282-0751

Other practice location 3

2428 Knob Creek Rd Ste 201
Johnson City, TN 37604-2396
Phone (423) 282-5054

Other practice location 4

1497 W Elk Ave Ste 22A
Elizabethton, TN 37643-2896
Phone (423) 547-3380

Other practice location 5

2050 Meadowview Pkwy
Kingsport, TN 37660-7475
Phone (423) 230-5000

Other practice location 6

2030 Temple Hill Rd Ste A
Erwin, TN 37650-8721
Phone (423) 735-4185

Other practice location 7

16000 Johnston Memorial Dr Ste 212A
Abingdon, VA 24211-7664
Phone (276) 258-1000

Other practice location 8

127 Health Care Dr Ste 3
Pennington Gap, VA 24277-2853
Phone (423) 230-5000

Other practice location 9

245 Medical Park Dr Ste A
Marion, VA 24354-1100
Phone (276) 378-1000

Other practice location 10

1410 Tusculum Blvd Ste 1500
Greeneville, TN 37745-5810
Phone (423) 638-2270

Other identifiers 6

IdentifierTypeStateIssuer
1801200506MedicaidVA
Q006912MedicaidTN
1801200506MedicaidNC
P01505609OtherTNRAILROAD MEDICARE
7100302680MedicaidKY
P01673823OtherVARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20140915001016 VA Practitioner - Nurse Practitioner 8123247764 Reassigns benefits to 2 organizations
I20141001001379 TN Practitioner - Nurse Practitioner 8123247764 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellmont Cardiology ServicesGroup PAC ID 5799970281, 137 clinicians

Practice addresses (Care Compare)

16000 Johnston Memorial Dr
Suite 212a
Abingdon, VA 24211-7664
Phone (276) 258-3740

2050 Meadowview Pkwy
Kingsport, TN 37660-7475
Phone (423) 230-5000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Aug 25, 2014 Accepting new patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Wellmont Cardiology Services Nurse Practitioner CurrentSince Aug 6, 2022 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Aug 25, 2014 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Aug 25, 2014 Accepting new patients
Blue Ridge Medical Management Corporation Nurse Practitioner Past Accepting new patients
Wellmont Medical Associates, Inc. PastSince Aug 6, 2022 Accepting new patients
Takoma Regional Hospital, Inc Past Accepting new patients
Solstas Lab Partners Group LLC Past Accepting new patients
Wellmont Physician Services Inc Nurse Practitioner Past Accepting new patients

Locations

1497 W Elk Ave
Ste 20
Elizabethton, TN 37643
Phone (423) 547-7380

1497 W Elk Ave
Ste 22A
Elizabethton, TN 37643
Phone (423) 542-8929

1410 Tusculum Blvd
Ste 1500
Greeneville, TN 37745
Phone (423) 638-2270

1019 W Oakland Ave
Ste 1
Johnson City, TN 37604
Phone (423) 915-5000

1021 W Oakland Ave
Ste 310
Johnson City, TN 37604
Phone (423) 302-6565

2 Professional Park Dr
Ste 15
Johnson City, TN 37604
Phone (423) 232-4867

2428 Knob Creek Rd
Ste 201
Johnson City, TN 37604
Phone (423) 262-4400

310 N State of Franklin Rd
Ste 400
Johnson City, TN 37604
Phone (423) 929-7393

2050 Meadowview Pkwy
Kingsport, TN 37660

16000 Johnston Memorial Dr
Fl Fourth
Abingdon, VA 24211
Phone (276) 258-4050

16000 Johnston Memorial Dr
Ste 212A
Abingdon, VA 24211
Phone (276) 258-1000

323 Falls Dr NW
Abingdon, VA 24210
Phone (276) 628-2612

245 Medical Park Dr
Ste A
Marion, VA 24354
Phone (276) 378-1000

127 Health Care Dr
Ste 3
Pennington Gap, VA 24277
Phone (276) 299-5000

Organizations & group practices 11

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 6

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": "1403222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1801200506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-302-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 N STATE OF FRANKLIN RD STE 400",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046051",
            "telephone_number": "423-979-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16000 Johnston Memorial Dr",
            "address_2": "Fourth Floor",
            "address_purpose": "LOCATION",
            "city": "Abingdon",
            "state": "VA",
            "postal_code": "242117664",
            "country_code": "US",
            "telephone_number": "276-258-4050",
            "fax_number": "276-258-4056",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "378 Marketplace Blvd Ste 5",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376042361",
            "country_code": "US",
            "telephone_number": "423-282-0751",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2428 Knob Creek Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376042396",
            "country_code": "US",
            "telephone_number": "423-282-5054",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1497 W Elk Ave Ste 22A",
            "address_purpose": "LOCATION",
            "city": "Elizabethton",
            "state": "TN",
            "postal_code": "376432896",
            "country_code": "US",
            "telephone_number": "423-547-3380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2050 Meadowview Pkwy",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376607475",
            "country_code": "US",
            "telephone_number": "423-230-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2030 Temple Hill Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Erwin",
            "state": "TN",
            "postal_code": "376508721",
            "country_code": "US",
            "telephone_number": "423-735-4185",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16000 Johnston Memorial Dr Ste 212A",
            "address_purpose": "LOCATION",
            "city": "Abingdon",
            "state": "VA",
            "postal_code": "242117664",
            "country_code": "US",
            "telephone_number": "276-258-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "127 Health Care Dr Ste 3",
            "address_purpose": "LOCATION",
            "city": "Pennington Gap",
            "state": "VA",
            "postal_code": "242772853",
            "country_code": "US",
            "telephone_number": "423-230-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "245 Medical Park Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "VA",
            "postal_code": "243541100",
            "country_code": "US",
            "telephone_number": "276-378-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1410 Tusculum Blvd Ste 1500",
            "address_purpose": "LOCATION",
            "city": "Greeneville",
            "state": "TN",
            "postal_code": "377455810",
            "country_code": "US",
            "telephone_number": "423-638-2270",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAILEY",
        "first_name": "CHARISMA",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-20",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024171841",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "18986",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801200506",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q006912",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801200506",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01505609",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100302680",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01673823",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.