NPIMap

Organization Active NPI

Pain Medicine Associates, P.C.

  • Psychologist
  • Johnson City, TN
National Provider Identifier
1962655696
Registry record updated Oct 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1084 Issued in TN
Legal business name
PAIN MEDICINE ASSOCIATES, P.C.
Practice address
101 Med Tech Pkwy
Suite 200
Johnson City, TN 37604-4007
Phone
(423) 232-6120
Fax
(423) 232-6125
NPI assigned
Oct 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2008

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

Authorized official

Name
Mrs. Tracy Bays, CPC
Title
Office Manager
Phone
(423) 232-6120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X 1084 TN Primary

Addresses

Primary practice location

101 Med Tech Pkwy
Suite 200
Johnson City, TN 37604-4007

Mailing address

101 Med Tech Pkwy
Suite 200
Johnson City, TN 37604-4007
Phone (423) 232-6120

Other identifiers 6

IdentifierTypeStateIssuer
3715213MedicaidTN
134016XXOtherTNPREFERRED CARE
CG3754OtherTNMEDICARE RAILROAD
373941500OtherTNDEPT OF LABOR
146990OtherTNANTHEM VA - BRISTOL
146991OtherTNANTHEM VA - KPT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040907001347 TN Part B Supplier - Clinic/Group Practice 6901702216 Receives reassigned benefits from 17 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bristol, TN; Kingsport, TN; Johnson City, TN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

101 Med Tech Pkwy
Ste 200
Johnson City, TN 37604
Phone (423) 232-6120

Practitioners & affiliated clinicians

Practitioners 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1962655696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MED TECH PKWY",
            "address_2": "SUITE 200",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044007",
            "telephone_number": "423-232-6120",
            "fax_number": "423-232-6125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MED TECH PKWY",
            "address_2": "SUITE 200",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044007",
            "telephone_number": "423-232-6120",
            "fax_number": "423-232-6125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN MEDICINE ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "BAYS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "423-232-6120",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "TN",
            "license": "1084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3715213",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "134016XX",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CG3754",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "373941500",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM VA - BRISTOL",
            "identifier": "146990",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM VA - KPT",
            "identifier": "146991",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; 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.