John David Tullos, M.D.
Individual provider Active NPI Sports Medicine (Orthopaedic Surgery) Physician · Dickson, TN
NPI 1104138908 · NPPES record last updated Mar 17, 2022
Key facts
- NPI
- 1104138908
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X
- License
- 54403 (TN)
- Practice address
- 127 Crestview Park Dr Ste 204
Dickson, TN 37055-2856 - Phone
- (615) 441-4545
- Fax
- (615) 441-4505
- NPI assigned
- Jul 8, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 9
Medicare Care Compare profile
- Specialty
- Sports Medicine
- Education
- University of Mississippi School of Medicine, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Amg-Hillside LLC
Practice addresses (Care Compare)
1275 E College St
Suite 2
Pulaski, TN 38478-4545
Phone (931) 363-3514
Hospital & facility affiliations
- NHC Homecare of Columbia
- Southern Tennessee Regional Health System Pulaski
- Southern Tennessee Regional Health System Lawrence
- Maury Regional Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hip replacement | 1-10 |
| Knee replacement | 1-10 |
| Upper limb (arm) arthroscopy (minimally invasive joint repair) | 1-10 |
| Removal of tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160810001291 | TN | Practitioner - Sports Medicine |
9739311812 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54403 | TN | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amg-Hillside LLC | Orthopaedic Surgery | Current | Accepting new patients |
| Amg-Hillside LLC | Orthopaedic Surgery | Current |
Accepting new patients |
| Amg-Hillside LLC | Current |
Accepting new patients | |
| Dickson Medical Associates, PC | Past | Accepting new patients | |
| Amg Hillside LLC | Orthopaedic Surgery | Past | Accepting new patients |
Locations
330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780
1275 E College St
Ste 2
Pulaski, TN 38478
Phone (931) 363-3514
202 Hillside Dr
Pulaski, TN 38478
Phone (931) 207-8397
204 Hillside Dr
Pulaski, TN 38478
Phone (931) 363-3514
Interoperability endpoints
- john.tullos.1@19363.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 54403 | TN | |
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | 54403 | TN | Yes |
Addresses
Primary practice location
127 Crestview Park Dr Ste 204
Dickson, TN 37055-2856
Mailing address
127 Crestview Park Dr Ste 209
Dickson, TN 37055-2856
Phone (615) 446-5121
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q022567 | Medicaid | TN |
Other providers in Dickson, TN
- Trueroots Compounding Pharmacy LLC
- Trueroots Compounding Pharmacy LLC
- Susan K Tuck
- Aimee Tucker
- Kayla Marie Tucker
- Andrea Paige Tummins
- Charles Tummins
- Jason Andrew Tummins
- Jessica Gentry Turner
- Elizabeth Ann Turrill
All providers in Dickson, TN · Sports Medicine (Orthopaedic Surgery) Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.