NPIMap

Individual provider Active NPI

Rance Ballard Wilbourn, MD

  • Neurology Physician
  • Germantown, TN
National Provider Identifier
1063676690
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
56737 Issued in TN
Practice address
2215 West St Ste 100
Germantown, TN 38138
Phone
(901) 440-8482
Fax
(901) 440-8582
NPI assigned
Jul 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X IP958 KY
Neurology Physician 2084N0400X 20766 MS
Neurology Physician 2084N0400X 51679 SC
Neurology Physician 2084N0400X 56737 TN Primary

Addresses

Primary practice location

2215 West St Ste 100
Germantown, TN 38138

Mailing address

2215 West St Ste 100
Germantown, TN 38138-3874
Phone (901) 440-8482

Other identifiers 3

IdentifierTypeStateIssuer
Q063676690MedicaidTN
04520877MedicaidMS
230387001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180102001114 SC Practitioner - Neurology 4789719816 Reassigns benefits to 1 organization
I20180719003632 TN Practitioner - Neurology 4789719816 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of South Alabama College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifestyle Neurology PCGroup PAC ID 6103164041, 2 clinicians

Practice addresses (Care Compare)

2215 W St
Germantown, TN 38138-3874
Phone (901) 440-8482

Hospital & facility affiliations

  • Regional One Health Hospital, Memphis, TN, CCN 440152
  • Baptist Memorial Hospital Hospital, Memphis, TN, CCN 440048
  • Baptist Memorial Hospital Desoto Hospital, Southaven, MS, CCN 250141
  • North Mississippi Medical Center Hospital, Tupelo, MS, CCN 250004
  • Methodist Hospitals of Memphis Hospital, Memphis, TN, CCN 440049

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
IP958KYMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Magnolia Nephrology Clinic Current Accepting new patients
Prisma Health University Medical Group Current Accepting new patients
Prisma Health University Medical Group CurrentSince Nov 27, 2017 Accepting new patients
Prisma Health University Medical Group CurrentSince Nov 27, 2017 Accepting new patients
Gulf Coast Heart Institute Past Accepting new patients
E Arthur Franklin MD PC Past Accepting new patients
Mittal Kidney and Dialysis PC Past Accepting new patients

Locations

3704 Highway 72 W
Corinth, MS 38834
Phone (662) 286-1499

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

200 Patewood Dr
Ste B350
Greenville, SC 29615
Phone (864) 454-4500

325 Medical Pkwy
Ste 200D
Greer, SC 29650
Phone (864) 797-9071

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GCFDAA
  • Direct secure messaging: rwilbourn32558@mlh.direct-ci.com

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1215993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1063676690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 WEST ST STE 100",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381383874",
            "telephone_number": "901-440-8482",
            "fax_number": "901-440-8582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 WEST ST STE 100",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "38138",
            "telephone_number": "901-440-8482",
            "fax_number": "901-440-8582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBOURN",
        "first_name": "RANCE",
        "middle_name": "BALLARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-14",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "KY",
            "license": "IP958",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MS",
            "license": "20766",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "SC",
            "license": "51679",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TN",
            "license": "56737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q063676690",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04520877",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "230387001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, TN

Sources for this page

Verify at the official NPI Registry.