Individual provider Active NPI

John F. Robertson III, MD

  • Surgery Physician
  • Johnson City, TN
National Provider Identifier
1851387872
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD36238 Issued in TN
Practice address
2 Professional Park Dr Ste 11
Johnson City, TN 37604-6584
Phone
(423) 975-5650
Fax
(423) 975-5652
NPI assigned
Sep 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD36238 TN Primary

Addresses

Primary practice location

2 Professional Park Dr Ste 11
Johnson City, TN 37604-6584

Mailing address

PO Box 52948
Knoxville, TN 37950-2948
Phone (865) 306-5700

Other identifiers 2

IdentifierTypeStateIssuer
30016502830002MedicaidVA
Q013108MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100215000401 TN Practitioner - General PracticePractitioner - General Surgery 2668547159 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General PracticeAlso: General Surgery
Education
University of Louisville School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Surgical Associates PLLCGroup PAC ID 1254224181, 61 clinicians

Practice addresses (Care Compare)

300 Med Tech Pkwy
Johnson City, TN 37604-2277
Phone (423) 302-1000

400 N State of Franklin Rd
Johnson City, TN 37604-6035
Phone (423) 431-6111

9430 Parkwest Blvd
Suite 310
Knoxville, TN 37923-4203
Phone (865) 690-5263

Hospital & facility affiliations

  • Franklin Woods Community Hospital Hospital, Johnson City, TN, CCN 440184
  • Johnson City Medical Center Hospital, Johnson City, TN, CCN 440063

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy17
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux13
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD36238TNMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Surgical Associates, PLLC Surgery CurrentSince Apr 22, 2022 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Jun 26, 2016 Accepting new patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Jun 26, 2016 Accepting new patients
Premier Surgical Associates, PLLC Surgery CurrentSince Apr 22, 2022 Accepting new patients
Mountain States Health Alliance Past Accepting new patients

Locations

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

101 Med Tech Pkwy
Ste 405
Johnson City, TN 37604
Phone (423) 929-2452

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

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

3 Professional Park Dr
Ste 31
Johnson City, TN 37604
Phone (423) 232-6900

2 Professional Park Dr
Ste 11
Johnson City, TN 37604
Phone (423) 434-0642

9430 Park West Blvd
Ste 310
Knoxville, TN 37923
Phone (865) 984-3413

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71045

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1851387872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52948",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379502948",
            "telephone_number": "865-306-5700",
            "fax_number": "865-584-7760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 PROFESSIONAL PARK DR STE 11",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046584",
            "telephone_number": "423-975-5650",
            "fax_number": "423-975-5652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "JOHN",
        "middle_name": "F.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "MD36238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30016502830002",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q013108",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.