JOHNSON CITY DOWNTOWN CLINIC DAY CENTER
NPI 1093990608
Clinic/Center - Federally Qualified Health Center (FQHC) in Johnson City, TN
About Johnson City Downtown Clinic Day Center NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JOHNSON CITY DOWNTOWN CLINIC DAY CENTER (NPI 1093990608) is a healthcare organization registered as a federally qualified health center (fqhc) in Johnson City, Tennessee and active in the NPI registry since January 2008. The organization holds a CLIA Microscopy certificate valid through April 18, 2027 and lists Betty J. King, Acting Chief Financial Officer, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Johnson City Downtown Clinic Day Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
45Medicare enrollment records show 45 clinicians reassign Medicare billing to Johnson City Downtown Clinic Day Center, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 27 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 5
Nearest to this location (20)
See all 45Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate for Provider-Performed Microscopy Procedures (PPMP) 44D0873186
East Tennessee State University Dba East Tn State University Johnson City Community Health Center · Johnson City, TNFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is East Tennessee State University's NPI number?
The NPI number for East Tennessee State University is 1093990608. It was assigned to this organization in the NPPES registry on January 2, 2008. The provider is doing business as Johnson City Downtown Clinic Day Center.
Where is East Tennessee State University located?
East Tennessee State University is located at 202 W Fairview Ave, Johnson City, TN 37604. The listed phone number is (423) 434-0894.
What is East Tennessee State University's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.
Is East Tennessee State University enrolled in Medicare?
Yes. East Tennessee State University is registered in the Medicare PECOS enrollment system.
When is East Tennessee State University's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Part A enrollment for this organization (Tennessee, Federally Qualified Health Center (FQHC)) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through East Tennessee State University?
According to the CMS Revalidation Reassignment List (October 2026 release), 45 clinicians in 5 Medicare specialties reassign their Medicare billing to East Tennessee State University. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (35), Clinical Social Worker (4) and Family Practice (4). Of these, 4 practice at this address and 27 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does East Tennessee State University hold a CLIA laboratory certificate?
Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 44D0873186) is associated with this NPI, valid through April 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does East Tennessee State University accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee and 1 other insurer list East Tennessee State University as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for East Tennessee State University was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Johnson City Downtown Clinic Day Center · NPI 1093990608
Federally Qualified Health Center (FQHC) organization in Johnson City, Tennessee. Organization record, active in the CMS NPPES registry since January 2, 2008.
## Identity
- **NPI:** 1093990608 (Entity type: Organization)
- **Enumerated:** January 2, 2008
- **Primary specialty:** Clinic/Center - Federally Qualified Health Center (FQHC) · taxonomy 261QF0400X
- **Legal business name:** East Tennessee State University
- **Organization subpart:** No
- **Authorized official:** Betty King, ACTING CHIEF FINANCIAL OFFICER
## Practice location
- **Address:** 202 W FAIRVIEW AVE, Johnson City, TN 37604-5611
- **Phone:** (423) 434-0894 · **Fax:** (423) 434-0666
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Part A, Tennessee, Federally Qualified Health Center (FQHC)) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 45 clinicians in 5 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (35), Clinical Social Worker (4), Family Practice (4); 4 practice at this address and 27 within 10 miles; [full list](https://npiprofile.com/npi/1093990608/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 21, 2022
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1093990608) · Data from the CMS NPPES public registry.