NPIMap

Organization Active NPI

Tri State Mountain Neurology Associates PC

  • Neurology Physician
  • Johnson City, TN
National Provider Identifier
1801823638
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
TRI STATE MOUNTAIN NEUROLOGY ASSOCIATES PC
Practice address
1321 Sunset Drive
Suite 11
Johnson City, TN 37604-7902
Phone
(423) 928-6174
Fax
(423) 926-2258
NPI assigned
Jun 27, 2006
Last updated
Oct 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Authorized official

Name
Nathaniel R Whaley, MDNPI 1245213545
Title
Secretary
Phone
(423) 928-6174

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

1321 Sunset Drive
Suite 11
Johnson City, TN 37604-7902

Mailing address

1321 Sunset Drive
Suite 11
Johnson City, TN 37604-7902
Phone (423) 928-6174

Other identifiers 3

IdentifierTypeStateIssuer
164888600OtherOWCP
000009788OtherTNBCBS
3380796MedicaidTN

Other names 1

  • Neurology Associates of Johnson City PC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071208000189 TN Part B Supplier - Clinic/Group Practice 4587753892 Receives reassigned benefits from 5 practitioners
Practice locations: Johnson City, TN

National Provider Directory

National Provider Directory

Locations

1321 Sunset Dr
Ste 11
Johnson City, TN 37604
Phone (423) 928-6174

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1801823638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 SUNSET DRIVE",
            "address_2": "SUITE 11",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376047902",
            "telephone_number": "423-928-6174",
            "fax_number": "423-926-2258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 SUNSET DRIVE",
            "address_2": "SUITE 11",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376047902",
            "telephone_number": "423-928-6174",
            "fax_number": "423-926-2258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE MOUNTAIN NEUROLOGY ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-27",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "WHALEY",
        "authorized_official_first_name": "NATHANIEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "423-928-6174",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP",
            "identifier": "164888600",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000009788",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3380796",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neurology Associates of Johnson City PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Neurology Associates of Johnson City PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; 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.