NPIMap

Individual provider Active NPI

William Ryan Bartz, D.O.

  • Family Medicine Physician
  • Selmer, TN
National Provider Identifier
1063450237
Registry record updated Jun 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1733 Issued in TN
Practice address
104 W Court Ave
Selmer, TN 38375-2102
Phone
(731) 437-2720
Fax
(731) 434-0388
NPI assigned
Jun 2, 2006
Last updated
Jun 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X DO1733 TN
Family Medicine Physician 207Q00000X 1733 TN Primary

Addresses

Primary practice location

104 W Court Ave
Selmer, TN 38375-2102

Mailing address

104 W Court Ave
Selmer, TN 38375-2102
Phone (731) 437-2720

Other identifiers 2

IdentifierTypeStateIssuer
4162040OtherTNBCBS TN
3319561MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051026001033 TN Practitioner - Family PracticePractitioner - Emergency Medicine 7517984859 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

104 W Court Ave
Selmer, TN 38375-2102
Phone (731) 437-2720

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision14
Removal of skin lesions53

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
1733TNMDMarriage & Family Therapist
DO1733TNMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Apex Health and Wellness PLLC CurrentSince Dec 15, 2021 Accepting new patients
West Tennessee Medical Group Inc Family Medicine Past Accepting new patients
Beechlake Emergency Physicians Emergency Medicine Past Accepting new patients
Bolivar General Hospital, Inc. Past Accepting new patients
Exigence Arkansas Tennessee LLC Past Accepting new patients
Bolivar General Hospital, Inc. Past Accepting new patients
Jackson Clinic PA Past Accepting new patients
Lexington Clinic Corp Emergency Medicine Past Accepting new patients
Todd's Discount Drugs Inc. PastSince Jan 10, 2021 Accepting new patients

Locations

104 W Court Ave
Selmer, TN 38375
Phone (731) 437-2720

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1063450237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 W COURT AVE",
            "city": "SELMER",
            "state": "TN",
            "postal_code": "383752102",
            "telephone_number": "731-437-2720",
            "fax_number": "731-645-5195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W COURT AVE",
            "city": "SELMER",
            "state": "TN",
            "postal_code": "383752102",
            "telephone_number": "731-437-2720",
            "fax_number": "731-434-0388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARTZ",
        "first_name": "WILLIAM",
        "middle_name": "RYAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "DO1733",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "1733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TN",
            "identifier": "4162040",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3319561",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Selmer, TN

Sources for this page

Verify at the official NPI Registry.