NPIMap

Organization Active NPI

Urology Group PC

  • Urology Physician
  • Germantown, TN
National Provider Identifier
1053346064
Registry record updated Nov 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
UROLOGY GROUP PC
Practice address
7550 Wolf River Blvd Ste 200
Germantown, TN 38138-1778
Phone
(901) 767-8158
NPI assigned
Jul 11, 2006
Last updated
Nov 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Angie Wilson
Title
Operations Manager
Phone
(901) 767-8158

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X NU
Urology Physician 208800000X NU Primary
Clinical Medical Laboratory 291U00000X NU

Addresses

Primary practice location

7550 Wolf River Blvd Ste 200
Germantown, TN 38138-1778

Mailing address

7550 Wolf River Blvd Ste 200
Germantown, TN 38138-1778
Phone (901) 767-8158

Other practice location 1

1727 Kirby Pkwy Ste 150
Memphis, TN 38120-4347
Phone (901) 767-8158

Other practice location 2

6005 Park Ave Ste 803
Memphis, TN 38119-5218
Phone (901) 767-8158

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040820000319 TN Part B Supplier - Clinic/Group Practice 9739153354 Receives reassigned benefits from 25 practitioners
Practice locations: Germantown, TN; Memphis, TN
O20070129000456 MS Part B Supplier - Clinic/Group Practice 9739153354 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Southaven, MS

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D1025920Urology Group, PC, the6005 Park Avenue, Suite 803, Memphis, TN 38119Provider-performed microscopyJul 12, 2027

National Provider Directory

National Provider Directory

Locations

363 Southcrest Cir
Ste 102
Southaven, MS 38671
Phone (662) 772-4615

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762992000000",
    "number": "1053346064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7550 WOLF RIVER BLVD STE 200",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381381778",
            "telephone_number": "901-767-8158",
            "fax_number": "901-767-1555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7550 WOLF RIVER BLVD STE 200",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381381778",
            "telephone_number": "901-767-8158"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1727 Kirby Pkwy Ste 150",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381204347",
            "country_code": "US",
            "telephone_number": "901-767-8158",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6005 Park Ave Ste 803",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381195218",
            "country_code": "US",
            "telephone_number": "901-767-8158",
            "fax_number": "901-767-1555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "UROLOGY GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "901-767-8158"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.