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Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

DR. KYLE DANE GOTFRIED MD
NPI 1205762085
Student in an Organized Health Care Education/Training Program in Johnson City, TN

Active since June 20, 2026PECOS Enrolled
917 W WALNUT ST, JOHNSON CITY, TN 37604(423) 439-6464(423) 439-7118 Get Directions Write a Review

NPPES record added: June 20, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Dr. Kyle Dane Gotfried Md NPPES

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

DR. KYLE DANE GOTFRIED MD (NPI 1205762085) is an individual student in an organized health care education/training program in Johnson City, Tennessee and active in the NPI registry since June 2026. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1205762085
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. KYLE DANE GOTFRIEDCredential: MD
Location Address917 W WALNUT STJohnson City, TN 37604-6527
Mailing Address917 W Walnut StJohnson City, TN 37604-6527 · (423) 439-6464 · Fax (423) 439-7118
Phone(423) 439-6464
Fax(423) 439-7118
Sole ProprietorNo
Enumeration DateJune 20, 2026
NPPES CertifiedJune 20, 2026
✔ NPI 1205762085 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
917 W WALNUT ST, Johnson City, TN 37604
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kyle Dane Gotfried Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NIKITA MARIE THOMPSON
Social Worker (Clinical)
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464
SALLY ELIZABETH CHIKOMB
Student in an Organized Health Care Education/Training Program
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464
MEDICAL EDUCATION ASSISTANCE CORPORATION
Family Medicine
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464
AUSTIN B HASH DO
Student in an Organized Health Care Education/Training Program
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464
LUKE STANLEY
Student in an Organized Health Care Education/Training Program
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-7118
DR. PAIGE MCCLEAR DO
Family Medicine
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464
JIM L WILSON M.D.
Family Medicine
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464
JOYCE ANNE TROXLER MD
Family Medicine
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464

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 Kyle Gotfried's NPI number?

The NPI number for Kyle Gotfried is 1205762085. It was assigned to this individual provider in the NPPES registry on June 20, 2026.

Where is Kyle Gotfried located?

Kyle Gotfried practices at 917 W Walnut St, Johnson City, TN 37604. The listed phone number is (423) 439-6464.

What is Kyle Gotfried's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Kyle Gotfried enrolled in Medicare?

Yes. Kyle Gotfried is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kyle Gotfried was last updated on June 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.