Individual provider Active NPI

Mary Diane Priesmeyer, LCSW

  • Clinical Social Worker
  • Johnson City, TN
National Provider Identifier
1922863208
Registry record updated Feb 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
8448 Issued in TN
Practice address
109 W Watauga Ave
Johnson City, TN 37604-5621
Phone
(423) 232-2600
Fax
(423) 232-2646
NPI assigned
Feb 16, 2024
Last updated
Feb 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 8448 TN Primary

Addresses

Primary practice location

109 W Watauga Ave
Johnson City, TN 37604-5621

Mailing address

1167 Spratlin Park Dr
Gray, TN 37615-6205
Phone (423) 467-3600

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240229001592 TN Practitioner - Clinical Social Worker 9537504519 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8448TNMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Frontier Health CurrentSince Feb 19, 2024 Accepting new patients
Frontier Health CurrentSince Feb 19, 2024 Accepting new patients

Locations

426 E G St
Elizabethton, TN 37643
Phone (423) 547-5950

109 W Watauga Ave
Johnson City, TN 37604
Phone (423) 232-2600

1167 Spratlin Park Dr
Johnson City, TN 37615
Phone (423) 232-2670

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": "1708041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1922863208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1167 SPRATLIN PARK DR",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376156205",
            "telephone_number": "423-467-3600",
            "fax_number": "423-467-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 W WATAUGA AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376045621",
            "telephone_number": "423-232-2600",
            "fax_number": "423-232-2646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIESMEYER",
        "first_name": "MARY",
        "middle_name": "DIANE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-16",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "8448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.