NPIMap

Organization Active NPI

Womens Diagnostic Group PLLC

  • Diagnostic Radiology Physician
  • Memphis, TN
National Provider Identifier
1104922392
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
WOMENS DIAGNOSTIC GROUP PLLC
Practice address
50 Humphreys Center
Suite 23
Memphis, TN 38120-2373
Phone
(901) 383-1194
Fax
(901) 383-8985
NPI assigned
Sep 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Authorized official

Name
Evelyn W. Gayden, M.D.NPI 1639281769
Title
Chief Manager
Phone
(901) 226-0811

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

50 Humphreys Center
Suite 23
Memphis, TN 38120-2373

Mailing address

PO Box 1000
Dept 34 Womens Diagnostic Group PLLC
Memphis, TN 38120
Phone (901) 383-1194

Other identifiers 6

IdentifierTypeStateIssuer
04483898MedicaidMS
05675086MedicaidMS
4053282OtherTNBCBS
3377147MedicaidTN
07421890MedicaidMS
8P034OtherARBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050504000129 TN Part B Supplier - Clinic/Group Practice 7113967795 Receives reassigned benefits from 6 practitioners
Practice locations: Memphis, TN
O20260331003301 OH Part B Supplier - Clinic/Group Practice 7113967795 Receives reassigned benefits from 1 practitioner
Practice locations: N Ridgeville, OH

National Provider Directory

National Provider Directory

Locations

350 N Humphreys Blvd
Ste 23
Memphis, TN 38120

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607299200000",
    "number": "1104922392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "address_2": "DEPT 34 WOMENS DIAGNOSTIC GROUP PLLC",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38120",
            "telephone_number": "901-383-1194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 HUMPHREYS CENTER",
            "address_2": "SUITE 23",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202373",
            "telephone_number": "901-383-1194",
            "fax_number": "901-383-8985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOMENS DIAGNOSTIC GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A",
        "authorized_official_last_name": "GAYDEN",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CHIEF MANAGER",
        "authorized_official_telephone_number": "901-226-0811",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04483898",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05675086",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4053282",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3377147",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07421890",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8P034",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.