Tri-City Pediactric Cardiology P C

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

Legal business name

TRI-CITY PEDIACTRIC CARDIOLOGY P C

Practice address

2312 Knob Creek Rd
Suite 208
Johnson City, TN 37604-2367

Phone

(423) 610-1099

Fax

(423) 610-1166

NPI assigned

Nov 15, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Ashok V Mehta, MD

Title

President and Ceo

Phone

(423) 610-1099

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• TRI-CITY PEDIACTRIC CARDIOLOGY P C Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 6

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

• Ashish B Madhok, MD

  • Pediatric Cardiology Physician
  • Johnson City, TN
  • NPI 1376533489
  Medicare reassignment NPD
• Jerry Don Walkup Jr., M.D.

  • Pediatric Cardiology Physician
  • Johnson City, TN
  • NPI 1578856985

  Single Specialty

  Medicare reassignment NPD
• Lacy Hicks, CPNP

  • Pediatric Cardiology Physician
  • Johnson City, TN
  • NPI 1396465621

  Single Specialty

  NPD
• Brooke Nicole Pennings, NP

  • Primary Care Nurse Practitioner
  • Johnson City, TN
  • NPI 1720641137
  NPD (past)
• Christine M. Rigsby, APN

  • Nurse Practitioner
  • Johnson City, TN
  • NPI 1710012125
  NPD (past)
• Otto H.P. Teixeira, MD

  • Pediatric Cardiology Physician
  • Johnson City, TN
  • NPI 1831184266
  NPD (past)

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333670400000",
    "number": "1841362555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3953",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376023953",
            "telephone_number": "423-610-1099",
            "fax_number": "423-610-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2312 KNOB CREEK RD",
            "address_2": "SUITE 208",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042367",
            "telephone_number": "423-610-1099",
            "fax_number": "423-610-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-CITY PEDIACTRIC CARDIOLOGY P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2012-04-06",
        "status": "A",
        "authorized_official_last_name": "MEHTA",
        "authorized_official_first_name": "ASHOK",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "423-610-1099",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3722336",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRI-CITY PEDIACTRIC CARDIOLOGY P C",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatric Cardiology Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Pediatric Cardiology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2012; 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.