John Douglas Haltom Jr., MD
Individual provider Active NPI Sports Medicine (Orthopaedic Surgery) Physician · Jackson, TN
NPI 1205948254 · NPPES record last updated Nov 2, 2015
Key facts
- NPI
- 1205948254
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X
- License
- MD44752 (TN)
- Practice address
- 24 Physicians Dr
Jackson, TN 38305-2070 - Phone
- (731) 661-9825
- Fax
- (731) 668-6757
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- University of Tennessee, HSC, College of Medicine, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Health Facilities Rehab Services Inc
West Tennessee Bone and Joint Clinic PC
Practice addresses (Care Compare)
1102 Sikes Ave
Sikeston, MO 63801-5021
50 Capital Ave
Jackson, TN 38305-5507
Phone (731) 661-9825
Hospital & facility affiliations
- Extendicare Home Health of West TN
- Jackson-Madison County General Hospital
- Dyersburg Regional Medical Center
- Lauderdale Community Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.05 of 100
- Promoting interoperability
- 98
- Improvement activities
- 40
- Cost
- 73.85
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hip replacement | 11 |
| Knee replacement | 25 |
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 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 |
|---|---|---|---|---|
| I20090911000227 | TN | Practitioner - Orthopedic Surgery | 2365543550 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD44752 | TN | MD | Sports Medicine (Orthopaedic Surgery) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West Tennessee Bone and Joint Clinic PC | Orthopaedic Surgery | Current |
Accepting new patients |
| Jackson Ophthalmology ASC LLC | Current | Accepting new patients |
Locations
2035 Saint John Ave
Dyersburg, TN 38024
Phone (731) 285-1393
24 Physicians Dr
Jackson, TN 38305
Phone (731) 661-9825
50 Capital Ave
Jackson, TN 38305
Phone (731) 661-9825
Interoperability endpoints
- john.haltom.1@3533.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | MD44752 | TN | Yes |
| Orthopaedic Surgery Physician | 207X00000X | MD44752 | TN |
Addresses
Primary practice location
24 Physicians Dr
Jackson, TN 38305-2070
Mailing address
24 Physicians Dr
Jackson, TN 38305-2070
Phone (731) 661-9825
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1517709 | Medicaid | TN |
Other providers in Jackson, TN
- Bailey Scott Hall
- Elizabeth Lee Hall
- Lauren Hall
- Cassie Halliburton
- Shelia Halliburton
- Sarah W. Hamil
- Amber C Hamilton
- Anna Catherine Hamilton
- Christina Hamilton
- Ericka L Hamilton
All providers in Jackson, 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 Nov 2, 2015. 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.