Individual provider Active NPI

Conrado B Sioson Jr., M.D.

  • Internal Medicine Physician
  • Jackson, TN
National Provider Identifier
1235356361
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD27620 Issued in TN
Practice address
587 Skyline Dr
Jackson, TN 38301-3911
Phone
(731) 424-8922
Fax
(731) 423-2922
NPI assigned
Apr 19, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 MD27620 TN Primary

Addresses

Primary practice location

587 Skyline Dr
Jackson, TN 38301-3911

Mailing address

587 Skyline Dr
Jackson, TN 38301-3911
Phone (731) 424-8922

Other identifiers 1

IdentifierTypeStateIssuer
3096923MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031212000421 TN Practitioner - Internal Medicine 8729984398 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WT Medical AssociatesGroup PAC ID 1951650613, 64 clinicians

Practice addresses (Care Compare)

101 Jackson Walk Plaza
Jackson, TN 38301-3008
Phone (731) 425-6900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.74 of 100Reported as apm
Quality
85.23
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD27620TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical Clinic of Jackson Internal Medicine Current Accepting new patients
WT Medical Associates Internal Medicine CurrentSince Sep 3, 2019 Accepting new patients
WT Medical Associates CurrentSince Sep 3, 2019 Accepting new patients

Locations

420 Wilkinson Dr
Fl 2
Dyersburg, TN 38024
Phone (731) 285-5133

101 Jackson Walk Plz
Jackson, TN 38301
Phone (731) 421-6950

1804 Highway 45 Byp
Ste 604
Jackson, TN 38305
Phone (731) 512-1273

367 Hospital Blvd
Jackson, TN 38305
Phone (731) 661-2000

587 Skyline Dr
Jackson, TN 38301
Phone (731) 421-6510

620 Skyline Dr
Jackson, TN 38301
Phone (731) 541-4923

Interoperability endpoints

  • Direct secure messaging: csioson18610@directepic.wth.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235356361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "587 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013911",
            "telephone_number": "731-424-8922",
            "fax_number": "731-423-2922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "587 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013911",
            "telephone_number": "731-424-8922",
            "fax_number": "731-423-2922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIOSON",
        "first_name": "CONRADO",
        "middle_name": "B",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD27620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3096923",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.