Mountain Region Family Medicine, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MOUNTAIN REGION FAMILY MEDICINE, PC

Practice address

444 Clinchfield Street
Ste 201
Kingsport, TN 37660-3683

Phone

(423) 230-2100

Fax

(423) 230-2112

NPI assigned

Dec 2, 2011

Organization subpart

No

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

Authorized official

Name

Ms. Wanda Y Trent

Title

Corporate Secretary

Phone

(423) 230-2109

Specialties & licenses 1

Addresses

Other identifiers 17

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly Brooke Gibson, FNP

  • Family Nurse Practitioner
  • Kingsport, TN
  • NPI 1588969463
  NPD
• Monna J. Nelms, NP

  • Family Nurse Practitioner
  • Kingsport, TN
  • NPI 1205205317
  NPD

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

{
    "created_epoch": "1322784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489104000000",
    "number": "1831467067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 CLINCHFIELD STREET",
            "address_2": "STE 201",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603683",
            "telephone_number": "423-230-2100",
            "fax_number": "423-230-2112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 CLINCHFIELD STREET",
            "address_2": "STE 201",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603683",
            "telephone_number": "423-230-2100",
            "fax_number": "423-230-2112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN REGION FAMILY MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-02",
        "last_updated": "2017-03-10",
        "status": "A",
        "authorized_official_last_name": "TRENT",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "CORPORATE SECRETARY",
        "authorized_official_telephone_number": "423-230-2109",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1003827205",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1538110309",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1154354900",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1164582862",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1528079910",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1548252638",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1861732968",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1881854594",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1356391098",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1477539542",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1526748",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1629089784",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1770534539",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1306897202",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1588676456",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (S. STEFFEY)",
            "identifier": "3386406",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD GROUP",
            "identifier": "4312365",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Troy Moss
• Whittaker Moss, DDS
• Mountain Empire Medical Transportation, LLC
• Mountain Region Family Medicine, PC
• Mountain Region Family Medicine, PC
• Mountain Region Speech and Hearing Center
• Mountain States Health Alliance
• Mountain States Health Alliance
• Mountain States Health Alliance
• Mountain States Health Alliance

• Family Medicine Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.