Individual provider Active NPI

Elisa J Lafountain, DO

  • Internal Medicine Physician
  • Johnson City, TN
National Provider Identifier
1992738702
Registry record updated Feb 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
1788 Issued in TN
Practice address
408 N State of Franklin Rd
Suite 24
Johnson City, TN 37604-6089
Phone
(423) 431-1810
Fax
(423) 431-1811
NPI assigned
Jul 8, 2006
Last updated
Feb 15, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 1788 TN Primary

Addresses

Primary practice location

408 N State of Franklin Rd
Suite 24
Johnson City, TN 37604-6089

Mailing address

408 N State of Franklin Rd
Suite 24
Johnson City, TN 37604-6089
Phone (423) 431-1810

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
I20060912000338 TN Practitioner - Internal Medicine 4486658184 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holston Medical Group PCGroup PAC ID 8224935754, 239 clinicians

Practice addresses (Care Compare)

105 W Stone Dr
Kingsport, TN 37660-3365
Phone (423) 857-2793

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Holston Medical Group PC Internal Medicine CurrentSince May 4, 2021 Accepting new patients
Wellmont Health System Past Accepting new patients
East Tennessee Medical Group, PC Internal Medicine Past Accepting new patients

Locations

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

350 Steeles Rd
#1
Bristol, TN 37620
Phone (423) 844-4925

105 W Stone Dr
Ste 1J
Kingsport, TN 37660
Phone (423) 378-7654

Interoperability endpoints

  • Direct secure messaging: elisalafountain@hmgpath.allscriptsdirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487116800000",
    "number": "1992738702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 N STATE OF FRANKLIN RD",
            "address_2": "SUITE 24",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046089",
            "telephone_number": "423-431-1810",
            "fax_number": "423-431-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 N STATE OF FRANKLIN RD",
            "address_2": "SUITE 24",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046089",
            "telephone_number": "423-431-1810",
            "fax_number": "423-431-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAFOUNTAIN",
        "first_name": "ELISA",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-08",
        "last_updated": "2017-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "1788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.