ENDOSCOPY CENTER OF NORTHEAST TENNESSEE, PC
NPI 1164488219
Clinic/Center - Ambulatory Surgical in Johnson City, TN

Q: What is Endoscopy Center Of Northeast Tennessee, PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Active since April 25, 2006CLIA 44D2066094 · Waiver

310 N STATE OF FRANKLIN RD, SUITE 202, JOHNSON CITY, TN 37604(423) 929-7111(423) 929-9448 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Endoscopy Center Of Northeast Tennessee, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ENDOSCOPY CENTER OF NORTHEAST TENNESSEE, PC (NPI 1164488219) is a healthcare organization registered as an ambulatory surgical in Johnson City, Tennessee and active in the NPI registry since April 2006. The organization holds a CLIA Waiver certificate valid through September 19, 2027 and lists Penny B Rutledge, Facility Administrator, as its authorized official.

NPPES Registry Identity

NPI1164488219

Entity TypeOrganization

Primary Taxonomy261QA1903X

Legal Business NameENDOSCOPY CENTER OF NORTHEAST TENNESSEE, PC

Location Address310 N STATE OF FRANKLIN RD, SUITE 202Johnson City, TN 37604-6008

Mailing Address310 N State Of Franklin Rd, Suite 202Johnson City, TN 37604-6008 · (423) 929-7111 · Fax (423) 929-9448

Phone(423) 929-7111

Fax(423) 929-9448

Organization SubpartNo

Authorized OfficialPenny B RutledgeFacility Administrator · (423) 929-7111

Enumeration DateApril 25, 2006

Last NPPES UpdateAugust 22, 2020

✔ NPI 1164488219 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities

Taxonomy Code261QA1903X

License✔ Licensed in TN · 0000000056

310 N STATE OF FRANKLIN RD, Johnson City, TN 37604

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Other Identifiers 1

Medicaid3287479TN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Endoscopy Center Of Northeast Tennessee, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Endoscopy Center Of Northeast Tennessee, PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Chakradhar Reddy, M.D

Internal Medicine

NPI 1548360332

310 N STATE OF FRANKLIN RD SUITE 202
Johnson City, TN 37604

(423) 929-7111

✔ PECOS✔ Accepts MedicareSame address

Source: 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 of Waiver 44D2066094

Endoscopy Center Of Northeast Tennessee PC · Johnson City, TN

Active · expires Sep 19, 2027

CLIA Number44D2066094

Laboratory TypeAmbulatory Surgery Center

Certificate Effective DateSeptember 20, 2025

Certificate Expiration DateSeptember 19, 2027

Laboratory DirectorPuneet Goenka

Laboratory Phone(423) 929-7111

Laboratory LocationEndoscopy Center Of Northeast Tennessee PC310 North State Of Franklin Road, Johnson City, TN 37604

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 9

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Biopsy of large bowel using a flexible endoscope 45380

A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.

404 services403 patients

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.

396 services388 patients

Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385

This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.

357 services357 patients

Colorectal cancer screening; colonoscopy on individual at high risk G0105

Colorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.

152 services152 patients

Dilation of esophagus 43450

Dilation of the esophagus is a procedure aimed to stretch or open up your esophagus (the tube connecting your mouth to your stomach) when it's narrow. It helps to improve swallowing and alleviate discomfort. It's typically performed using a flexible tube or balloon, under sedation.

120 services116 patients

Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43235

This procedure, known as an upper endoscopy, involves inserting a thin, flexible tube with a camera down the throat to examine the esophagus, stomach, and upper small bowel. It helps diagnose conditions like ulcers or inflammation.

113 services108 patients

Frequently 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 Endoscopy Center Of Northeast Tennessee, PC's NPI number?

The NPI number for Endoscopy Center Of Northeast Tennessee, PC is 1164488219. It was assigned to this organization in the NPPES registry on April 25, 2006.

Where is Endoscopy Center Of Northeast Tennessee, PC located?

Endoscopy Center Of Northeast Tennessee, PC is located at 310 N State Of Franklin Rd Suite 202, Johnson City, TN 37604. The listed phone number is (423) 929-7111.

What is Endoscopy Center Of Northeast Tennessee, PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Is Endoscopy Center Of Northeast Tennessee, PC enrolled in Medicare?

Yes. Endoscopy Center Of Northeast Tennessee, PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Endoscopy Center Of Northeast Tennessee, PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Endoscopy Center Of Northeast Tennessee, PC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Endoscopy Center Of Northeast Tennessee, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 44D2066094) is associated with this NPI, valid through September 19, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Endoscopy Center Of Northeast Tennessee, PC accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee and 2 other insurers list Endoscopy Center Of Northeast Tennessee, PC 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 Endoscopy Center Of Northeast Tennessee, PC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.