Individual provider Active NPI

Michael Tomblyn, MD

  • Radiation Oncology Physician
  • Memphis, TN
National Provider Identifier
1083758544
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
62366 Issued in TN
Practice address
6019 Walnut Grove Rd
Memphis, TN 38120-2113
Phone
(901) 226-0340
Fax
(901) 226-0349
NPI assigned
Feb 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 036140023 IL
Therapeutic Radiology Physician 2085R0203X ME104123 FL
Radiation Oncology Physician 2085R0001X 62366 TN Primary

Addresses

Primary practice location

6019 Walnut Grove Rd
Memphis, TN 38120-2113

Mailing address

965 Ridge Lake Blvd Ste 103
Memphis, TN 38120-9446

Other practice location 1

2160 S 1st Ave
Maywood, IL 60153-3328
Phone (708) 216-9000

Other identifiers 1

IdentifierTypeStateIssuer
000764300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20210719002780 TN Practitioner - Radiation Oncology 5092851949 Reassigns benefits to 1 organization
I20251227000330 MS Practitioner - Radiation Oncology 5092851949 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Rush Medical College of Rush University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2996 Kate Bond Rd
Bartlett, TN 38133-4062

36 Capital Way
Suite E
Atoka, TN 38004-7986
Phone (901) 837-6801

6019 Walnut Grove Rd
Memphis, TN 38120-2113
Phone (901) 226-3882

6225 Humphreys Blvd
Memphis, TN 38120-2373
Phone (901) 227-9000

7601 Southcrest Pkwy
Southaven, MS 38671-4739
Phone (662) 772-2130

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.87 of 100Reported as group
Quality
64.75
Promoting interoperability
100
Improvement activities
40
Cost
74.81

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Memorial Medical Group Inc CurrentSince Jun 1, 2021 Accepting new patients
Baptist Memorial Medical Group Inc Radiation Oncology CurrentSince Jun 1, 2021 Accepting new patients
Baptist Memorial Health Services, Inc. of Mississippi Past Accepting new patients

Locations

255 Baptist Blvd
Ste 301
Columbus, MS 39705
Phone (662) 244-2288

7601 Southcrest Pkwy
Southaven, MS 38671
Phone (662) 349-4000

36 Capital Way
Ste E
Atoka, TN 38004
Phone (901) 837-6801

2996 Kate Bond Rd
Ste 100
Bartlett, TN 38133
Phone (901) 383-5570

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

965 Ridge Lake Blvd
Ste 103
Memphis, TN 38120
Phone (901) 227-3221

1109 E Reelfoot Ave
Ste F
Union City, TN 38261
Phone (731) 884-1412

Interoperability endpoints

  • Direct secure messaging: mtomblyn468435@direct.bmhcc.org

Organizations & group practices 3

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 2

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": "1171670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1083758544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 RIDGE LAKE BLVD STE 103",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209446",
            "fax_number": "901-227-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6019 WALNUT GROVE RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202113",
            "telephone_number": "901-226-0340",
            "fax_number": "901-226-0349"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2160 S 1st Ave",
            "address_purpose": "LOCATION",
            "city": "Maywood",
            "state": "IL",
            "postal_code": "601533328",
            "country_code": "US",
            "telephone_number": "708-216-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOMBLYN",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-17",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "IL",
            "license": "036140023",
            "primary": false
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "FL",
            "license": "ME104123",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "TN",
            "license": "62366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000764300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.