NPIMap

Individual provider Active NPI

Roland Keith Huffaker, M. D.

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Johnson City, TN
National Provider Identifier
1881608693
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X
License
MD44928 Issued in TN
Practice address
1319 Sunset Dr
Suite 103
Johnson City, TN 37604
Phone
(423) 439-7246
Fax
(423) 282-4698
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X MD44928 TN Primary
Gynecology Physician 207VG0400X MD44928 TN

Addresses

Primary practice location

1319 Sunset Dr
Suite 103
Johnson City, TN 37604

Mailing address

PO Box 699
Mountain Home, TN 37684-0699
Phone (423) 439-7272

Other identifiers 2

IdentifierTypeStateIssuer
1514562MedicaidTN
3714470OtherTNGROUP MEDICAID #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090806000819 TN Practitioner - Obstetrics/Gynecology 4981603529 Reassigns benefits to 1 organization
Practice locations: Johnson City, TN

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
East Tennessee State University Quillen College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1319 Sunset Dr
Suite 103
Johnson City, TN 37604-7901
Phone (423) 439-7246

BLDG 52 Lake Dr
Mountain Home, TN 37684-0001
Phone (423) 439-8000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD44928TNMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Education Assistance Corporation CurrentSince Jul 8, 2009 Accepting new patients

Locations

1319 Sunset Dr
Ste 103
Johnson City, TN 37604
Phone (423) 439-7246

222 E Main St
Johnson City, TN 37604
Phone (423) 433-6200

325 N State of Franklin Rd
Fl 1
Johnson City, TN 37604
Phone (423) 439-7272

400 E State of Franklin Rd
Johnson City, TN 37601
Phone (423) 433-6200

Organizations & group practices 1

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 7

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": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1881608693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376840699",
            "telephone_number": "423-439-7272",
            "fax_number": "423-439-7235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 SUNSET DR",
            "address_2": "SUITE 103",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-439-7246",
            "fax_number": "423-282-4698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUFFAKER",
        "first_name": "ROLAND",
        "middle_name": "KEITH",
        "credential": "M. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "TN",
            "license": "MD44928",
            "primary": true
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "TN",
            "license": "MD44928",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1514562",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID #",
            "identifier": "3714470",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.