Jeffrey V Anderson, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Clarksville, TN
NPI 1144201567 · NPPES record last updated Aug 29, 2022
Key facts
- NPI
- 1144201567
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 27669 (TN)
- Practice address
- 490 Dunlop LN
Clarksville, TN 37040-5007 - Phone
- (931) 245-8100
- Fax
- (931) 245-8161
- NPI assigned
- Nov 11, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Louisiana State University School of Medicine in Shreveport, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Premier Medical Group PC
Practice addresses (Care Compare)
490 Dunlop LN
Clarksville, TN 37040-5007
Phone (931) 245-7000
Hospital & facility affiliations
- Vanderbilt Clarksville Hospital
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 |
|---|---|---|---|---|
| I20100219000020 | TN | Practitioner - Obstetrics/Gynecology | 0941390769 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021650 | LA | MD | Obstetrics & Gynecology Physician |
| 27669 | TN | MD | Obstetrics & Gynecology Physician |
| J5685 | TX | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Medical Group PC | Current |
Accepting new patients | |
| Clarksville Health System, LLC | Past | Accepting new patients |
Locations
1832 Memorial Dr
Clarksville, TN 37043
Phone (931) 645-3552
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 021650 | LA | |
| Obstetrics & Gynecology Physician | 207V00000X | J5685 | TX | |
| Obstetrics & Gynecology Physician | 207V00000X | 27669 | TN | Yes |
Addresses
Primary practice location
490 Dunlop LN
Clarksville, TN 37040-5007
Mailing address
PO Box 3799
Clarksville, TN 37043-3799
Phone (931) 245-7000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q004439 | Medicaid | TN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jeffrey.anderson.2@7977.direct.athenahealth.com | Direct | Premier Medical Group PC |
Other providers in Clarksville, TN
- Donna Jean Anderson
- Elizabeth Anderson
- Emma Anderson
- Geoffrey Anderson
- Jeffrey Karl Anderson
- Kamisha Anderson
- Kara Nicole Anderson
- Laporsche Anderson
- Laura Anderson
- Lindsey Berry Anderson
All providers in Clarksville, TN · Obstetrics & Gynecology 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 Aug 29, 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.