Individual provider Active NPI

Alan J McLeod, MD

  • Diagnostic Radiology Physician
  • Memphis, TN
National Provider Identifier
1063527455
Registry record updated Aug 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
21315 Issued in TN
Practice address
6019 Walnut Grove
Memphis, TN 38159
Phone
(901) 226-5000
NPI assigned
Aug 19, 2006
Last updated
Aug 30, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 21315 TN Primary

Addresses

Primary practice location

6019 Walnut Grove
Memphis, TN 38159

Mailing address

PO Box 5083
Memphis, TN 38101-5083
Phone (901) 747-1000

Other identifiers 6

IdentifierTypeStateIssuer
3061383MedicaidTN
95492OtherARBCBS
120531001MedicaidAR
203041918MedicaidMO
00010604MedicaidMS
130548OtherTNBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS, AR3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20050420001039 TN Practitioner - Diagnostic Radiology 0941248975 Reassigns benefits to 2 organizations
I20101210000840 MS Practitioner - Diagnostic Radiology 0941248975 Reassigns benefits to 1 organization
I20170208001146 AR Practitioner - Diagnostic Radiology 0941248975 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21315TNMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Apr 4, 2017 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Current Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Apr 4, 2017 Accepting new patients
West Tennessee Imaging, LLC Diagnostic Radiology CurrentSince Jun 1, 2015 Accepting new patients
Baptist Memorial Hospital Past Accepting new patients
Neurology Clinic, PC PastSince Apr 1, 2020 Accepting new patients
Neurology Clinic, PC Past Accepting new patients

Locations

1111 Windover Rd
Jonesboro, AR 72401
Phone (870) 935-5432

4800 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 732-2100

6019 Walnut Grove Rd
Memphis, TN 38120
Phone (901) 226-3190

7600 Wolf River Blvd
Memphis, TN 38138
Phone (615) 550-6049

7600 Wolf River Blvd
Ste 200
Memphis, TN 38138
Phone (901) 747-1000

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346284800000",
    "number": "1063527455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5083",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381015083",
            "telephone_number": "901-747-1000",
            "fax_number": "901-747-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6019 WALNUT GROVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38159",
            "telephone_number": "901-226-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCLEOD",
        "first_name": "ALAN",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2012-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TN",
            "license": "21315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3061383",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "95492",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120531001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203041918",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00010604",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "130548",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.