EAST TENNESSEE RECOVERY, PLLC
NPI 1114462215
Internal Medicine - Addiction Medicine in Johnson City, TN

NPI Status: Active since December 27, 2016

Contact Information

2408 SUSANNAH ST STE 1
JOHNSON CITY, TN
ZIP 37601
Phone: (423) 434-6677
Fax: (423) 461-0000

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Insurance Plans Accepted
Secondary Locations
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Internal Medicine
Addiction Medicine
Accepts Insurance
CLIA Number: 44D2135461
CLIA Cert. Type: Physician Office
CLIA Exp. Date: 06-14-2027

About EAST TENNESSEE RECOVERY, PLLC

This page provides the complete NPI Profile along with additional information for East Tennessee Recovery, Pllc, an internist established in Johnson City, Tennessee operating as a Internal Medicine, focusing in addiction medicine . The healthcare provider is registered in the NPI registry with number 1114462215 assigned on December 2016. The practitioner's primary taxonomy code is 207RA0401X. The provider is registered as an organization and their NPI record was last updated one year ago. The provider's . The authorized official of this NPI record is Daniel Tackling (Cfo)

NPI: 1114462215
Provider Legal Name: EAST TENNESSEE RECOVERY, PLLC
Other Organization Name
Other Name Type: (6)
Entity Type: Organization
Location Address: 2408 SUSANNAH ST STE 1 JOHNSON CITY, TN 37601
Location Phone: (423) 434-6677
Location Fax: (423) 461-0000
Mailing Address: 2408 SUSANNAH ST STE 1 JOHNSON CITY, TN 37601
Mailing Phone: (423) 434-6677
Mailing Fax: (423) 461-0000
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 12-27-2016
Last Update Date: 12-16-2025
Code Navigator

An internist like East Tennessee Recovery, Pllc is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

Location Map

Secondary Locations

19380 US Highway 58
Castlewood, VA 24224
(276) 762-2172
1662 Bonham Rd
Bristol, VA 24201
(276) 644-9899
2011 2nd St
Richlands, VA 24641
(276) 345-9900
137 Court St SE
Abingdon, VA 24210
(276) 477-1400
1725 Park Ave SW
Norton, VA 24273
(276) 409-5922
18948 US Highway 58
Castlewood, VA 24224
(276) 762-2172

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Internal Medicine Addiction Medicine
Taxonomy Code: 207RA0401X
Type: Allopathic & Osteopathic Physicians
Taxonomy Description: An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No.	Taxonomy Code	Type	Classification / Specialization
1	251S00000X	Agencies	Community/Behavioral Health
2	261QM1300X	Ambulatory Health Care Facilities	Clinic/Center Multi-Specialty
3	261QR0405X	Ambulatory Health Care Facilities	Clinic/Center Rehabilitation, Substance Use Disorder

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Ambetter from Arkansas Health & Wellness

Choice Bronze HSA (QualChoice) - POS
Complete Gold - PPO
Complete Gold + Vision + Adult Dental - PPO
Connected Silver - PPO
Connected Silver (QualChoice) - POS
Connected Silver (QualChoice) + Vision + Adult Dental - POS
Connected Silver (QualChoiceLife) - PPO
Connected Silver (QualChoiceLife) + Vision + Adult Dental - PPO
Connected Silver + Vision + Adult Dental - PPO
Elite Bronze - PPO

Ambetter from Home State Health

Complete Gold - EPO
Complete Gold + Vision + Adult Dental - EPO
Complete Silver - EPO
Complete Silver + Vision + Adult Dental - EPO
Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO
Everyday Gold - EPO
Everyday Gold + Vision + Adult Dental - EPO

Ambetter from Magnolia Health

Choice Bronze HSA - HMO
Choice Bronze HSA + Vision + Adult Dental - HMO
Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Everyday Bronze - HMO
Everyday Bronze + Vision + Adult Dental - HMO
Everyday Gold - HMO
Everyday Gold + Vision + Adult Dental - HMO
Standard Expanded Bronze - HMO
Standard Expanded Bronze + Vision + Adult Dental - HMO

Ambetter of Alabama

Complete Gold - EPO
Complete Gold + Vision + Adult Dental - EPO
Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Elite Gold - EPO
Elite Gold + Vision + Adult Dental - EPO
Enhanced Diabetes Care Silver with $0 Drug Options - EPO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO

Ambetter of North Carolina

Clear Silver with $0 Insulin Options - HMO
Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Complete Gold with Atrium Health - HMO
Complete Gold with Atrium Health + Vision + Adult Dental - HMO
Elite Bronze - HMO
Elite Bronze + Vision + Adult Dental - HMO
Elite Bronze with Atrium Health - HMO
Elite Bronze with Atrium Health + Vision + Adult Dental - HMO
Enhanced Asthma/COPD Care Silver with $0 Drug Options - HMO

Ambetter of Tennessee

Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Elite Gold - EPO
Elite Gold + Vision + Adult Dental - EPO
Enhanced Diabetes Care Silver with $0 Drug Options - EPO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO
Everyday Gold - EPO
Everyday Gold + Vision + Adult Dental - EPO

Oscar Insurance Company

Bronze Classic Standard - EPO
Bronze Elite + PCP Saver Plus - EPO
Bronze Simple - EPO
Bronze Simple Breathe Easy with Enhanced COPD Benefits - EPO
Bronze Simple Chronic Care CKM - EPO
Bronze Simple Diabetes - EPO
Gold Classic Standard - EPO
Gold Elite - EPO
Silver Classic - EPO
Silver Classic Standard - EPO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: DANIEL TACKLING
Authorized Official Title: CFO
Authorized Official Phone: (423) 434-6677

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State
2017139831	MEDICAID (05)	VA
7100519480	MEDICAID (05)	KY
Q026013	MEDICAID (05)	TN

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 44D2135461
Facility Type: Physician Office
Certificate Effective Date: June 15, 2025
Certificate Expiration Date: June 14, 2027
Laboratory Director: DR. JASON D. VECCHIA
Certificate Type: Certificate of Waiver
Certificate Type Description: This CLIA certificate is issued to East Tennessee Recovery, Pllc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1114462215, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 55. The final step is to find the difference between that total and the next multiple of ten (60 - 55 = 5).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 2

Pos 4

Unchanged

Pos 5

Doubled → 8

Pos 6

Unchanged

Pos 7

Doubled → 4

Pos 8

Unchanged

Pos 9

Doubled → 2

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 1 → 2 4 → 8 2 → 4 1 → 2

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 1 + 2 + 4 + 8 + 6 + 4 + 2 + 2 + 24 = 55

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 55 is 60. The difference is the calculated check digit.

60 - 55 = 5

This NPI is valid

The calculated check digit is 5, which matches the last digit of 1114462215.