Individual provider Active NPI

Phillip Glass, MD

  • Psychiatry Physician
  • Johnson City, TN
National Provider Identifier
1962023051
Registry record updated Jan 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
72291 Issued in TN
Practice address
403 N State of Franklin Rd
Johnson City, TN 37604-6034
Phone
(423) 431-7111
Fax
(423) 431-7092
NPI assigned
Apr 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 72291 TN Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

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

Mailing address

1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 952-2111

Other practice location 1

Building 52 Lake Drive
Mountain Home, TN 37684
Phone (423) 439-8000

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241024000008 TN Practitioner - Psychiatry 8022541457 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1497 W Elk Ave
Elizabethton, TN 37643-2896

400 N State of Franklin Rd
Johnson City, TN 37604-6035
Phone (423) 431-4847

408 N State of Franklin Rd
Johnson City, TN 37604-6035
Phone (423) 431-4946

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Medical Management Corporaiton CurrentSince Sep 22, 2024 Accepting new patients
Medical Education Assistance Corporation Psychiatry CurrentSince May 1, 2020 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Sep 22, 2024 Accepting new patients
Blue Ridge Medical Management Corporation Current Accepting new patients

Locations

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

403 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-7042

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

1021 W Oakland Ave
Ste 310
Johnson City, TN 37604
Phone (423) 302-6565

Organizations & group practices 4

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 4

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": "1588204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768176000000",
    "number": "1962023051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-952-2111"
        },
        {
            "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": "423-431-7111",
            "fax_number": "423-431-7092"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Building 52 Lake Drive",
            "address_purpose": "LOCATION",
            "city": "Mountain Home",
            "state": "TN",
            "postal_code": "37684",
            "country_code": "US",
            "telephone_number": "423-439-8000",
            "fax_number": "423-439-2200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLASS",
        "first_name": "PHILLIP",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-30",
        "last_updated": "2026-01-12",
        "certification_date": "2026-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "72291",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.