Mary Rebekah Jimenez

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

36821 Issued in TN

Practice address

403 N State of Franklin Rd
Johnson City, TN 37604-6034

Phone

(423) 388-9961

NPI assigned

Jun 29, 2023

Last updated

Apr 28, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medical Education Assistance CorporationGroup PAC ID 3870491269, 168 clinicians

Blue Ridge Medical Management CorporationGroup PAC ID 9739099441, 283 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Johnson City Medical Center Hospital, Johnson City, TN, CCN 440063

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Blue Ridge Medical Management Corporation

  dba First Assist Urgent Care

  • Urgent Care Clinic/Center
  • Elizabethton, TN
  • NPI 1144380833
  Medicare reassignment Care Compare group NPD
• Medical Education Assistance Corporation

  dba ETSU Physicians and Associates

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1235180480
  Medicare reassignment Care Compare group NPD
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Psychiatry Physician
  • Johnson City, TN
  • NPI 1326058272
  NPD
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Family Medicine Physician
  • Johnson City, TN
  • NPI 1982553756
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mountain States Health Alliance

  dba Woodridge Hospital

  • Psychiatric Hospital Unit
  • Johnson City, TN
  • NPI 1023434339
  Care Compare affiliation
• Mountain States Health Alliance

  dba Johnson City Medical Center

  • Psychiatric Hospital Unit
  • Johnson City, TN
  • NPI 1962915652
  Care Compare affiliation
• Mountain States Health Alliance

  dba Johnson City Medical Center

  • General Acute Care Hospital
  • Johnson City, TN
  • NPI 1972606465
  Care Compare affiliation

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

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777334400000",
    "number": "1912684028",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 N STATE OF FRANKLIN RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046034",
            "telephone_number": "423-388-9961"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Professional Park Dr Ste 21",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046584",
            "country_code": "US",
            "telephone_number": "423-379-8120",
            "fax_number": "423-379-8153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "MARY",
        "middle_name": "REBEKAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-29",
        "last_updated": "2026-04-28",
        "certification_date": "2026-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "36821",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "TN",
            "license": "246367",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912684028",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q098155",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cindy Jewett, CRNA
• John Marshall Jewett, D.M.D.
• Seth Michael Jewett
• Ethan Jilek
• Luisa Jimenez-Ruble, PSYD
• JJ Beans at Mooneys LLC (Mooneys Pharmacy)
• JJ Beans at Mooneys LLC (Mooney's Pharmacy)
• John Lawson Surgical Group
• John Lawson Surgical Group, PC
• John Marshall Jewett DMD PLLC

• Psychiatric/Mental Health Nurse Practitioner in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.