Individual provider Active NPI

Sandra Diane Churchill, FNP

  • Family Nurse Practitioner
  • Johnson City, TN
National Provider Identifier
1912985748
Registry record updated Feb 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN83123 Issued in TN
Practice address
401 E Main St
Johnson City, TN 37601-4877
Phone
(423) 929-2584
Fax
(423) 722-2060
NPI assigned
Jan 3, 2006
Last updated
Feb 16, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN83123 TN Primary

Addresses

Primary practice location

401 E Main St
Johnson City, TN 37601-4877

Mailing address

401 E Main St
Johnson City, TN 37601-4877
Phone (423) 929-2584

Other identifiers 1

IdentifierTypeStateIssuer
1912985748OtherNPI NUMBER

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070801000054 TN Practitioner - Nurse Practitioner 8123119435 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
East Tennessee State University Quillen College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Care PLLCGroup PAC ID 1850448580, 40 clinicians

Practice addresses (Care Compare)

1500 W Elk Ave
Elizabethton, TN 37643-3776
Phone (423) 543-2584

Merit-based Incentive Payment System (MIPS)

Final score
88.39 of 100Reported as group
Quality
86.98
Promoting interoperability
92
Improvement activities
40
Cost
80.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN83123TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Abingdon Physician Partners Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518739200000",
    "number": "1912985748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E MAIN ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376014877",
            "telephone_number": "423-929-2584",
            "fax_number": "423-722-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E MAIN ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376014877",
            "telephone_number": "423-929-2584",
            "fax_number": "423-722-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCHILL",
        "first_name": "SANDRA",
        "middle_name": "DIANE",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-03",
        "last_updated": "2018-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "RN83123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1912985748",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.