Organization Active NPI

East Tennessee Radiation Oncology, P.C.

  • Radiation Oncology Physician
  • Knoxville, TN
National Provider Identifier
1962589150
Registry record updated Aug 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
EAST TENNESSEE RADIATION ONCOLOGY, P.C.
Practice address
1915 White Ave
Knoxville, TN 37916-2300
Phone
(865) 541-1155
Fax
(865) 988-5658
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2023

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

Authorized official

Name
Janie L Johnson
Title
Authorized Agent
Phone
(865) 803-4321

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

1915 White Ave
Knoxville, TN 37916-2300

Mailing address

PO Box 24120
Knoxville, TN 37933-2120
Phone (865) 803-4321

Other identifiers 1

IdentifierTypeStateIssuer
3370058MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070810000144 TN Part B Supplier - Clinic/Group Practice 6103917729 Receives reassigned benefits from 12 practitioners
Practice locations: Knoxville, TN; Sevierville, TN; Morristown, TN; Crossville, TN

National Provider Directory

National Provider Directory

Locations

Knoxville, TN 37995

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691020800000",
    "number": "1962589150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24120",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379332120",
            "telephone_number": "865-803-4321",
            "fax_number": "865-988-5658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 WHITE AVE",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379162300",
            "telephone_number": "865-541-1155",
            "fax_number": "865-988-5658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE RADIATION ONCOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JANIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "865-803-4321"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3370058",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.