INDIAN PATH PAVILION
NPI 1417050980
Psychiatric Unit in Kingsport, TN

Active since September 07, 2006
2300 PAVILION DR, KINGSPORT, TN 37660(423) 857-5500(423) 857-7078 Get Directions Write a Review

NPPES record last updated: October 15, 2015. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Indian Path Pavilion NPPES

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

INDIAN PATH PAVILION (NPI 1417050980) is a healthcare organization registered as a psychiatric unit in Kingsport, Tennessee and active in the NPI registry since September 2006. The organization lists Mary L Krutak, Svp/cfo, as its authorized official.

NPPES Registry Identity

NPI1417050980
Entity TypeOrganization
Primary Taxonomy273R00000X
Legal Business NameMOUNTAIN STATES HEALTH ALLIANCE
Location Address2300 PAVILION DRKingsport, TN 37660-4622
Mailing Address311 Princeton RdJohnson City, TN 37601-2026 · (423) 431-1941 · Fax (423) 431-1244
Fax(423) 857-7078
Organization SubpartNo
Authorized OfficialMary L KrutakSvp/cfo · (423) 431-6111
Enumeration DateSeptember 7, 2006
Last NPPES UpdateOctober 15, 2015
✔ NPI 1417050980 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatric UnitHospital Units
Taxonomy Code273R00000X
License✔ Licensed in TN · 0000000134
Definition
In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems on the basis of physicians' orders and approved nursing care plans. Long-term care may include intensive supervision to the chronically mentally ill, mentally disordered or other mentally incompetent persons; (2) For Medicare, a distinct part of a general acute care hospital admitting only patients whose admission to the unit is required for active treatment, whose treatment is of an intensity that can be provided only in an inpatient hospital setting, and whose condition is described by a psychiatric principal diagnosis contained in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual or in Chapter 5 (Mental Disorders) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The unit must furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. The unit must maintain medical records that permit determination of the degree and intensity of treatment provided to individuals who are furnished services in the unit; the unit must meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning.
2300 PAVILION DR, Kingsport, TN 37660

Other Names 1

Doing Business AsIndian Path Pavilion

Other Identifiers 11

Medicaid4699873MI
Medicaid4400176NC
Medicare OSCAR/certification44S0176TN
Medicaid00672239MS
Medicaid01600113KY
Medicaid091618800FL
Medicaid000127730SC
Medicaid0938025OH
Other17505000Megellan
Medicaid000363855XGA
Medicaid004401760VA

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Indian Path Pavilion is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

17

Medicare enrollment records show 17 clinicians reassign Medicare billing to Indian Path Pavilion, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 4

Nurse Practitioner9
Hematology/Oncology3
Internal Medicine3
Family Practice2

Clinicians, nearest first (17)

Nurse Practitioner
NPI 1649915893
111 W STONE DR STE 200
Kingsport, TN 37660
(423) 723-2030
✔ PECOS✔ Accepts Medicare2.1 mi
Internal Medicine
NPI 1316903099
111 W STONE DR STE 200
Kingsport, TN 37660
(423) 723-2030
✔ PECOS✔ Accepts Medicare2.1 mi
Hematology/Oncology
NPI 1356758239
1 PROFESSIONAL PARK DR STE 21
Johnson City, TN 37604
(423) 232-6900
✔ PECOS✔ Accepts Medicare16 mi
Internal Medicine
NPI 1871907147
1 PROFESSIONAL PARK DR STE 21
Johnson City, TN 37604
(423) 232-6900
✔ PECOS✔ Accepts Medicare18 mi
Nurse Practitioner
NPI 1346632783
1 PROFRESSIONAL PARK DR SUITE 21
Johnson City, TN 37604
(423) 232-6900
✔ PECOS✔ Accepts Medicare18 mi
Nurse Practitioner
NPI 1750005492
1 PROFESSIONAL PARK DR STE 21
Johnson City, TN 37604
(423) 232-6900
✔ PECOS✔ Accepts Medicare18 mi
Nurse Practitioner
NPI 1316272453
1 PROFESSIONAL PARK DR STE 21
Johnson City, TN 37604
(423) 232-6900
✔ PECOS✔ Accepts Medicare18 mi
Family Practice
NPI 1457644254
1497 W ELK AVE SUITE 21
Elizabethton, TN 37643
(423) 542-7420
✔ PECOS✔ Accepts Medicare21 mi
Nurse Practitioner
NPI 1487329298
1 PROFESSIONAL PARK DR STE 21
Johnson City, TN 37604
(423) 232-6900
✔ PECOS✔ Accepts Medicare26 mi
Nurse Practitioner
NPI 1740716927
1 PROFESSIONAL PARK DR STE 21
Johnson City, TN 37604
(423) 232-6900
✔ PECOS✔ Accepts Medicare26 mi
Family Practice
NPI 1609455880
1901 S SHADY ST
Mountain City, TN 37683
(423) 727-1100
✔ PECOS✔ Accepts Medicare40 mi
Nurse Practitioner
NPI 1578819439
1901 S SHADY STREET
Mountain City, TN 37683
(423) 727-1150
✔ PECOS✔ Accepts Medicare40 mi
Nurse Practitioner
NPI 1437874294
1901 S SHADY ST
Mountain City, TN 37683
(423) 727-1100
✔ PECOS✔ Accepts Medicare40 mi
Nurse Practitioner
NPI 1366962631
1901 S SHADY ST
Mountain City, TN 37683
(423) 727-1103
✔ PECOS✔ Accepts Medicare41 mi
Internal Medicine
NPI 1982898193
12180 ALDER ST
Meadowview, VA 24361
(276) 695-0205
✔ PECOS✔ Accepts Medicare41 mi
Hematology/Oncology
NPI 1700246394
88 MDG/SGHJ 4881 SUGAR MAPLE DR
Wright Patterson Afb, OH 45433
(816) 885-9531
✔ PECOS✔ Accepts Medicare240 mi
Hematology/Oncology
NPI 1801156765
3551 ROGER BROOKE DR
Fort Sam Houston, TX 78234
(210) 916-4808
✔ PECOS✔ Accepts Medicare1,043 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Mountain States Health Alliance's NPI number?

The NPI number for Mountain States Health Alliance is 1417050980. It was assigned to this organization in the NPPES registry on September 7, 2006. The provider is doing business as Indian Path Pavilion.

Where is Mountain States Health Alliance located?

Mountain States Health Alliance is located at 2300 Pavilion Dr, Kingsport, TN 37660. The listed phone number is (423) 857-5500.

What is Mountain States Health Alliance's specialty?

The primary specialty registered for this NPI is Psychiatric Unit with taxonomy code 273R00000X.

Is Mountain States Health Alliance enrolled in Medicare?

Yes. Mountain States Health Alliance is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mountain States Health Alliance?

According to the CMS Revalidation Reassignment List (October 2026 release), 17 clinicians in 4 Medicare specialties reassign their Medicare billing to Mountain States Health Alliance. 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 (9), Hematology/Oncology (3) and Internal Medicine (3). Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Mountain States Health Alliance was last updated on October 15, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.