Johnathon Drake Bishop, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

66365 Issued in TN

Practice address

111 Otis Smith Dr
Clarksville, TN 37043-8940

Phone

(931) 553-6666

Fax

(931) 553-6681

NPI assigned

Apr 3, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: johnathon.bishop.1@31800.direct.athenahealth.com

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.

• Grace Pediatrics PLLC

  • Pediatrics Physician
  • Smyrna, TN
  • NPI 1467781690
  NPD (past)

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1922504554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 OTIS SMITH DR",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370438940",
            "telephone_number": "931-553-6666",
            "fax_number": "931-553-6681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 OTIS SMITH DR",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370438940",
            "telephone_number": "931-553-6666",
            "fax_number": "931-553-6681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISHOP",
        "first_name": "JOHNATHON",
        "middle_name": "DRAKE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-03",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "66365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin Paul Bilodeau, PHARMD
• Jaye Bilyeu
• Christopher A Binkley, OT
• David B Birnbaum, MD
• Lauren Bischoff, SLP-CCC
• Kimberly Bishop, LMSW
• Amanda Black
• Amanda Moore Black, RN
• Donald Allen Black, PA-C
• Joshua Ewing Black, PHARMD

• Pediatrics Physician in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Pediatrics Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.