NPIMap

Individual provider Active NPI

Cayla Rose Mutter, PA-C

  • Medical Physician Assistant
  • Bristol, TN
National Provider Identifier
1841849650
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0110-006851 Issued in VA
Practice address
350 Blountville Hwy Ste 205
Bristol, TN 37620-1671
Phone
(423) 968-6650
NPI assigned
Sep 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0110-006851 VA Primary

Addresses

Primary practice location

350 Blountville Hwy Ste 205
Bristol, TN 37620-1671

Mailing address

350 Blountville Hwy Ste 205
Bristol, TN 37620-1671
Phone (423) 968-2446

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200203002627 VA Practitioner - Physician Assistant 9739515149 Reassigns benefits to 1 organization
I20230206001830 TN Practitioner - Physician Assistant 9739515149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Duke University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellmont Medical Associates IncGroup PAC ID 8123291739, 432 clinicians

Practice addresses (Care Compare)

111 W Stone Dr
Kingsport, TN 37660-6027

350 Blountville Hwy
Bristol, TN 37620-1671

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3996TNMDAddiction (Substance Use Disorder) Counselor
0110-006851VAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmont Health System Current Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Mar 5, 2023 Accepting new patients
Wellmont Medical Associates Inc CurrentSince Apr 3, 2023 Accepting new patients
Express Family Care, LLC PastSince Oct 1, 2022 Accepting new patients

Locations

350 Blountville Hwy
Ste 205
Bristol, TN 37620
Phone (423) 968-2732

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

391 Falls Dr NW
Abingdon, VA 24210
Phone (276) 628-4406

1990 Holton Ave E
Big Stone Gap, VA 24219
Phone (276) 523-3111

Interoperability endpoints

  • Direct secure messaging: cbaker86224@direct.carilionclinic.org
  • Direct secure messaging: cmutter316290@balladhealth.medalliesdirect.net

Organizations & group practices 5

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 5

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": "1567641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1841849650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 BLOUNTVILLE HWY STE 205",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376201671",
            "telephone_number": "423-968-2446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 BLOUNTVILLE HWY STE 205",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376201671",
            "telephone_number": "423-968-6650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTTER",
        "first_name": "CAYLA",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-05",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110-006851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, TN

Sources for this page

Verify at the official NPI Registry.