Individual provider Active NPI

Brian T Fowler, M.D.

  • Ophthalmology Physician
  • Memphis, TN
National Provider Identifier
1093987893
Registry record updated Feb 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
48454 Issued in TN
Practice address
1068 Cresthaven Rd Ste 400
Memphis, TN 38119-0845
Phone
(901) 448-6650
Fax
(901) 302-2486
NPI assigned
Apr 1, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 48454 TN Primary

Addresses

Primary practice location

1068 Cresthaven Rd Ste 400
Memphis, TN 38119-0845

Mailing address

1068 Cresthaven Rd Ste 300
Memphis, TN 38119-0809
Phone (901) 866-8864

Other practice location 1

930 Madison Ave Ste 200
Memphis, TN 38103-3452
Phone (901) 448-6650

Other identifiers 6

IdentifierTypeStateIssuer
003181478AMedicaidGA
193108001MedicaidAR
005372219MedicaidMS
182749MedicaidAL
1528624MedicaidTN
1093987893MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20120709000655 TN Practitioner - Ophthalmology 5092970418 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of Virginia School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ut Medical Group IncGroup PAC ID 3173435369, 98 clinicians

Practice addresses (Care Compare)

930 Madison Ave
Suite 200
Memphis, TN 38103-3410
Phone (901) 448-6650

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.15 of 100Reported as group
Quality
59.97
Promoting interoperability
100
Improvement activities
40
Cost
80.93

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Medical Group, Inc. Ophthalmology CurrentSince Jul 1, 2012 Accepting new patients
Ut Medical Group Inc Ophthalmology CurrentSince Jul 1, 2012 Accepting new patients

Locations

1068 Cresthaven Rd
Ste 400
Memphis, TN 38119
Phone (901) 448-6650

930 Madison Ave
Ste 200
Memphis, TN 38103
Phone (901) 448-6650

1407 Union Ave
Ste 700
Memphis, TN 38104
Phone (901) 866-8360

1068 Cresthaven Rd
Ste 300
Memphis, TN 38119
Phone (901) 683-0024

Interoperability endpoints

  • Direct secure messaging: bfowler23293@mlh.direct-ci.com

Organizations & group practices 2

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": "1207008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740096000000",
    "number": "1093987893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1068 CRESTHAVEN RD STE 300",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381190809",
            "telephone_number": "901-866-8864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1068 CRESTHAVEN RD STE 400",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381190845",
            "telephone_number": "901-448-6650",
            "fax_number": "901-302-2486"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "930 Madison Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381033452",
            "country_code": "US",
            "telephone_number": "901-448-6650",
            "fax_number": "901-302-2486",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "BRIAN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-01",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TN",
            "license": "48454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003181478A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "193108001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005372219",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182749",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528624",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093987893",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.