Active NPI
Robert Martin Eiseman, MD
- Pediatrics Physician
- Memphis, TN
National Provider Identifier
1164595922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 19731
- Practice address
- 806 Estate PL
Memphis, TN 38120-0600 - Phone
- (901) 767-3620
- Fax
- (901) 683-0285
- NPI assigned
- Nov 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 19731 | TN | Primary |
Addresses
Primary practice location
806 Estate PL
Memphis, TN 38120-0600
Mailing address
1211 Union Ave Ste 330
Memphis, TN 38104-6655
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q005992 | Medicaid | TN | |
| 04300772 | Medicaid | MS | |
| 6013571 | Other | TN | BCBS |
| 206449001 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19731 | TN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Care Group LLC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728864000000",
"number": "1164595922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1211 UNION AVE STE 330",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381046655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "806 ESTATE PL",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381200600",
"telephone_number": "901-767-3620",
"fax_number": "901-683-0285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EISEMAN",
"first_name": "ROBERT",
"middle_name": "MARTIN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-17",
"last_updated": "2024-10-14",
"certification_date": "2024-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TN",
"license": "19731",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Q005992",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04300772",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "6013571",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "206449001",
"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 Oct 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.