Individual provider Active NPI

Samuel O Massey III, M.D.

  • Diagnostic Radiology Physician
  • Johnson City, TN
National Provider Identifier
1912956277
Registry record updated Feb 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
31318 Issued in TN
Practice address
1301 Sunset Dr
Ste 3
Johnson City, TN 37604-7906
Phone
(423) 926-4966
Fax
(423) 926-1823
NPI assigned
May 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 31318 TN Primary

Addresses

Primary practice location

1301 Sunset Dr
Ste 3
Johnson City, TN 37604-7906

Mailing address

1301 Sunset Dr
Ste 3
Johnson City, TN 37604-7906
Phone (423) 926-4966

Other identifiers 9

IdentifierTypeStateIssuer
3840825MedicaidTN
Q007699MedicaidTN
1912956277MedicaidVA
300104374OtherTNRAILROAD MEDICARE
64017064OtherKYKENTUCKY MEDICAID
89063JFOtherNCNORTH CAROLINA MEDICAID
7222238OtherVAVIRGINIA MEDICAID
3125936OtherTNBCBS
100026452OtherTNPHP TNCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20111201000734 TN Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 6507948676 Reassigns benefits to 2 organizations
I20250721000169 VA Practitioner - Diagnostic Radiology 6507948676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
University of Mississippi School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blue Ridge Radiology PCGroup PAC ID 7416860473, 77 clinicians

Practice addresses (Care Compare)

1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 844-2200

105 Fairlea CT
Lynchburg, VA 24503-2164
Phone (423) 968-1144

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 244-6800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31318TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Medical Management Corporation CurrentSince Dec 1, 2015 Accepting new patients
Vista Radiology, PC. Diagnostic Radiology CurrentSince May 15, 2016 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Dec 1, 2015 Accepting new patients
Blue Ridge Radiology, P.C. Diagnostic Radiology CurrentSince Jun 1, 2025 Accepting new patients
Blue Ridge Medical Management Corporation Current Accepting new patients

Locations

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

4289 Bonny Oaks Dr
Ste 106
Chattanooga, TN 37406

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

100 Greenway Cir
Erwin, TN 37650
Phone (423) 743-1271

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

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

Dept 888302
Knoxville, TN 37995

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 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": "1146873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487203200000",
    "number": "1912956277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 SUNSET DR",
            "address_2": "STE 3",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376047906",
            "telephone_number": "423-926-4966",
            "fax_number": "423-926-1823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 SUNSET DR",
            "address_2": "STE 3",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376047906",
            "telephone_number": "423-926-4966",
            "fax_number": "423-926-1823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASSEY",
        "first_name": "SAMUEL",
        "middle_name": "O",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-06",
        "last_updated": "2017-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TN",
            "license": "31318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3840825",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q007699",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912956277",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300104374",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KENTUCKY MEDICAID",
            "identifier": "64017064",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA MEDICAID",
            "identifier": "89063JF",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA MEDICAID",
            "identifier": "7222238",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3125936",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP TNCARE",
            "identifier": "100026452",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.