NPIMap

Individual provider Active NPI

Amy Elise Funderburk Mock, M.D.

  • Internal Medicine Physician
  • Memphis, TN
National Provider Identifier
1114919370
Registry record updated Nov 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD31772 Issued in TN
Practice address
4100 Austin Peay Hwy
Memphis, TN 38128-2502
Phone
(901) 844-1431
NPI assigned
Aug 15, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD31772 TN Primary

Addresses

Primary practice location

4100 Austin Peay Hwy
Memphis, TN 38128-2502

Mailing address

PO Box 770390
Memphis, TN 38177-0390
Phone (901) 844-1431

Other identifiers 1

IdentifierTypeStateIssuer
3843367MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110902000167 TN Practitioner - HospitalistPractitioner - Internal MedicinePractitioner - Physical Medicine and Rehabilitation 7618147448 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine, Physical Medicine and Rehabilitation
Education
University of Tennessee, HSC, College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Amy Funderburk MD PCGroup PAC ID 3779934187, 3 clinicians

Practice addresses (Care Compare)

1255 Lynnfield St
Suite 101
Memphis, TN 38119

1282 Union Ave
Memphis, TN 38104-3414
Phone (901) 761-6157

PO Box
Suite 770390
Memphis, TN 38177

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Amy Funderburk, MD PC Internal Medicine CurrentSince Dec 1, 2023 Accepting new patients
Encompass Health Methodist Rehabilitation Hospital, LP Past Accepting new patients
Methodist Healthcare - Memphis Hospitals Past Accepting new patients
Methodist Healthcare - Memphis Hospitals Past Accepting new patients

Locations

6263 Poplar Ave
Ste 1052
Memphis, TN 38119
Phone (901) 831-6881

4100 Austin Peay Hwy
Memphis, TN 38128
Phone (901) 213-5400

1282 Union Ave
Memphis, TN 38104
Phone (662) 822-7454

Interoperability endpoints

  • Direct secure messaging: afunderbur@yourcarecommunity.org

Organizations & group practices 4

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": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701302400000",
    "number": "1114919370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 770390",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381770390",
            "telephone_number": "901-844-1431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 AUSTIN PEAY HWY",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381282502",
            "telephone_number": "901-844-1431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNDERBURK MOCK",
        "first_name": "AMY",
        "middle_name": "ELISE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-15",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD31772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3843367",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.