East Tennessee State University - Medicare Primary Care in Johnson City, TN

  1. Home
  2. Primary Care Clinics
  3. TN
  4. Johnson City
East Tennessee State University is a medicare enrolled primary clinic (Clinic/center - Federally Qualified Health Center (fqhc)) in Johnson City, Tennessee. The current practice location for East Tennessee State University is 202 W Fairview Ave, Johnson City, Tennessee. For appointments, you can reach them via phone at (423) 434-0894. The mailing address for East Tennessee State University is 365 Stout Drive Box 70403, Johnson City, Tennessee and phone number is (423) 439-4515.

East Tennessee State University is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1093990608. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (423) 434-0894.

Contact Information

East Tennessee State University
202 W Fairview Ave
Johnson City
TN 37604-5611
(423) 434-0894
(423) 434-0666

Map and Direction


Primary Care Clinic Profile

Full NameEast Tennessee State University
SpecialityClinic/Center
Location202 W Fairview Ave, Johnson City, Tennessee
Authorized Official Name and PositionBetty J. King (ACTING CHIEF FINANCIAL OFFICER)
Authorized Official Contact4234394414
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
East Tennessee State University
365 Stout Drive Box 70403
Johnson City
TN 37614-1703

Ph: (423) 439-4515		East Tennessee State University
202 W Fairview Ave
Johnson City
TN 37604-5611

Ph: (423) 434-0894

NPI Details:

NPI Number1093990608
Provider Enumeration Date01/02/2008
Last Update Date07/21/2022

Medicare PECOS Information:

Medicare PECOS PAC ID2769394774
Medicare Enrollment IDO20031212000403

Medical Identifiers

Medical identifiers for East Tennessee State University such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1093990608NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
261QF0400XClinic/center - Federally Qualified Health Center (fqhc) (* (Not Available))Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. East Tennessee State University acts as a billing entity for following providers:
Provider NameLinda S Greene
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1366508996
PECOS PAC ID: 7012972615
Enrollment ID: I20041123000454
Provider NameJennifer D Stewart Glenn
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1457383671
PECOS PAC ID: 9537115944
Enrollment ID: I20050329001060
Provider NameCarrie N Lingerfelt
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1497784136
PECOS PAC ID: 4880635937
Enrollment ID: I20050518001056
Provider NameKimberly R Ferguson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1316943814
PECOS PAC ID: 0042317661
Enrollment ID: I20070516000296
Provider NameAmanda M Stoltz
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1427243278
PECOS PAC ID: 8123194024
Enrollment ID: I20080828000553
Provider NameSharon D Wilder
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1659511483
PECOS PAC ID: 8921156894
Enrollment ID: I20090501000513
Provider NameAvinash G Reddy
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1487858692
PECOS PAC ID: 1658431051
Enrollment ID: I20090909000293
Provider NameKayla N Norman-smith
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1265763262
PECOS PAC ID: 0840316634
Enrollment ID: I20100929001184
Provider NameNancy P Seal
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1023339975
PECOS PAC ID: 8527254788
Enrollment ID: I20101130000656
Provider NameJudith A Rice
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1770512642
PECOS PAC ID: 0143496745
Enrollment ID: I20120103000708
Provider NameAmanda S Moorhouse
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1679889356
PECOS PAC ID: 1355524778
Enrollment ID: I20120925000728
Provider NameAmanda K Reichenbach
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1659709673
PECOS PAC ID: 1052548005
Enrollment ID: I20131218001235
Provider NameSarah A Taylor
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1649696709
PECOS PAC ID: 8527282730
Enrollment ID: I20140609002520
Provider NameLisa M Williams-gunter
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1881010908
PECOS PAC ID: 3173747201
Enrollment ID: I20140611002285
Provider NameRetha D Gentry
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1760883680
PECOS PAC ID: 7113149907
Enrollment ID: I20141111001412
Provider NameApril H Morrison
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1548718752
PECOS PAC ID: 4789972787
Enrollment ID: I20161006001487
Provider NameLisa A Trent
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1215486279
PECOS PAC ID: 1850670720
Enrollment ID: I20161116002492
Provider NameRebecca Morrison
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1245238914
PECOS PAC ID: 0648551176
Enrollment ID: I20161221001211
Provider NameJoy E Mclain
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1730480724
PECOS PAC ID: 8820372287
Enrollment ID: I20170302000602
Provider NameChristopher L Garner
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1083000780
PECOS PAC ID: 3173807559
Enrollment ID: I20170302001615
Provider NameRebecca E Flora-waterman
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1043425689
PECOS PAC ID: 5991082786
Enrollment ID: I20170504000149
Provider NameJason S Nicholson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1790237394
PECOS PAC ID: 8325305428
Enrollment ID: I20171128001507
Provider NameLeslie Renee Barlow
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1255842878
PECOS PAC ID: 2365510732
Enrollment ID: I20180103003317
Provider NamePaige Noel Mullins
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1831554575
PECOS PAC ID: 3476817404
Enrollment ID: I20180427001829
Provider NameAngela D Flemmer
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1891230777
PECOS PAC ID: 8123373396
Enrollment ID: I20180613000133
Provider NameTalisha Ettina Leeann Troutt
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1639696784
PECOS PAC ID: 2961759113
Enrollment ID: I20180719002077
Provider NameChristina Nicole Morton
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1164999041
PECOS PAC ID: 2062749351
Enrollment ID: I20190808003576
Provider NameNatalie Grace Wigle
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1710522636
PECOS PAC ID: 6103242029
Enrollment ID: I20200821001581
Provider NameCarmen Melissa Gerarde Jones
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1285308239
PECOS PAC ID: 9537564463
Enrollment ID: I20210816002579
Provider NameMeredith Mccook Prosak
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1932861671
PECOS PAC ID: 3971991266
Enrollment ID: I20211019000250
Provider NameAshley M Claytore
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1639832884
PECOS PAC ID: 6103215280
Enrollment ID: I20211110002926
Provider NameLisa M Scholz
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1164734885
PECOS PAC ID: 7315265105
Enrollment ID: I20211119002335
Provider NameVictoria Paige Ryans
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1740934249
PECOS PAC ID: 2567856347
Enrollment ID: I20220221000648
Provider NameErica Petree
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1275506255
PECOS PAC ID: 3678967783
Enrollment ID: I20220304001741
Provider NameWhitley R Wright
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1396471223
PECOS PAC ID: 6709269533
Enrollment ID: I20220811002270
Provider NameErin Danielle Hogan
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1073915948
PECOS PAC ID: 4981929551
Enrollment ID: I20230204000300
Provider NameKristen Smith
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1740039858
PECOS PAC ID: 4486196706
Enrollment ID: I20240603000442
Provider NameHaley Edwards Malone
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1487408415
PECOS PAC ID: 5092257246
Enrollment ID: I20240604001449
Provider NameBeth D Crouch
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1245890631
PECOS PAC ID: 0143763144
Enrollment ID: I20240619000080
Provider NameKimberly Owens
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1477334134
PECOS PAC ID: 0244676351
Enrollment ID: I20240620001320
Provider NameJacqueline Grooms Oliver
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1467817353
PECOS PAC ID: 1951737758
Enrollment ID: I20240712003481
Provider NameMiranda Celeste Russell
Provider TypePractitioner - Mental Health Counselor
Provider IdentifiersNPI Number: 1346572591
PECOS PAC ID: 2860924917
Enrollment ID: I20241015001690

Reviews and Comments


Clinic/Center in Johnson City, TN

Mcc, Inc.
Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 501 E Watauga Ave, Johnson City, TN 37601
Phone: 423-722-8446    Fax: 423-722-5674
Medical Education Assistance Corporation
Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 917 W Walnut St, Johnson City, TN 37604
Phone: 423-439-6464    Fax: 423-439-7118
Wyche & Wyche, M.d., P.c.
Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 2406 Susannah St, Johnson City, TN 37601
Phone: 423-282-2542    Fax: 423-282-5447
Imperial Healthcare Services
Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 1604 Lamons Ln Ste 230, Johnson City, TN 37604
Phone: 423-930-5168    Fax: 423-328-0193
New Life Chiropractic And Wellness Inc
Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 514 E Watauga Ave, Johnson City, TN 37601
Phone: 423-928-4101    
Blue Ridge Medical Management Corporation
Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 310 N State Of Franklin Rd, Ste 301a, Johnson City, TN 37604
Phone: 423-431-6816    Fax: 423-431-2983
State Of Franklin Healthcare Associates Pllc
Primary Care Clinic
Medicare: Medicare Enrolled
Practice Location: 2528 Wesley St, Suite 2, Johnson City, TN 37601
Phone: 423-794-2430    Fax: 423-283-9719

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.