INDIAN PATH PAVILION
NPI 1417050980
Psychiatric Unit in Kingsport, TN
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
Specialties & Licenses
Other Names 1
Other Identifiers 11
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
17Medicare 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
Clinicians, nearest first (17)
Wright Patterson Afb, OH 45433
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.