NPIMap

Organization Active NPI

East Tennessee State University

  • Federally Qualified Health Center (FQHC)
  • Johnson City, TN
National Provider Identifier
1982905576
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST TENNESSEE STATE UNIVERSITY
Practice address
1134-1136 E. Main Street
Johnson City, TN 37601
Phone
(423) 722-0808
Fax
(423) 929-2930
NPI assigned
Nov 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ms. Betty J King
Title
Acting Chief Financial Officer
Phone
(423) 439-4414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1134-1136 E. Main Street
Johnson City, TN 37601

Mailing address

365 Stout Drive Box 70403
Johnson City, TN 37614-1703
Phone (423) 439-4515

Other identifiers 1

IdentifierTypeStateIssuer
1522314MedicaidTN

Other names 1

  • JCDC/JCHA Partners for Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031212000403 TN Part B Supplier - Clinic/Group Practice 2769394774 Receives reassigned benefits from 44 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Johnson City, TN; Sneedville, TN

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Tax ID family
East Tennessee State University20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

1134 E Main St
#1136
Johnson City, TN 37601

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1289520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1982905576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 STOUT DRIVE BOX 70403",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376141703",
            "telephone_number": "423-439-4515",
            "fax_number": "423-439-5780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1134-1136 E. MAIN STREET",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37601",
            "telephone_number": "423-722-0808",
            "fax_number": "423-929-2930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-12",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "BETTY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ACTING CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "423-439-4414",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1522314",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JCDC/JCHA Partners for Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 21, 2022; 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.