Active NPI
Dejo Viprakasit, MD
- Urology Physician
- Covington, TN
National Provider Identifier
1255312096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- MD11008
- Practice address
- 1995 Hwy 51 South
Suite 104
Covington, TN 38019 - Phone
- (901) 476-1135
- Fax
- (901) 476-1136
- NPI assigned
- Nov 9, 2005
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Urology Physician | 208800000X | MD11008 | TN | Primary |
Addresses
Primary practice location
1995 Hwy 51 South
Suite 104
Covington, TN 38019
Mailing address
PO Box 388
1995 Hwy 51 South Suite 104
Covington, TN 38019
Phone (901) 476-1135
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3383546 | Medicaid | TN | |
| 2007928 | Other | TN | BLUE CROSS |
| 4031846 | Other | AETNA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD11008 | TN | MD | Urology Physician |
Interoperability endpoints
- https://api.platform.athenahealth.com/3309/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255312096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 388",
"address_2": "1995 HWY 51 SOUTH SUITE 104",
"city": "COVINGTON",
"state": "TN",
"postal_code": "38019",
"telephone_number": "901-476-1135",
"fax_number": "901-476-1136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1995 HWY 51 SOUTH",
"address_2": "SUITE 104",
"city": "COVINGTON",
"state": "TN",
"postal_code": "38019",
"telephone_number": "901-476-1135",
"fax_number": "901-476-1136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIPRAKASIT",
"first_name": "DEJO",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "TN",
"license": "MD11008",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3383546",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "2007928",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4031846",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Covington, TN
- Deborah L Vanbeukering, D.O.
- Andrew Richard Vancleve, DPH
- Robyn Y. Vanderford, FNP
- Huy VI
- Carroll Logan Vincent, APN ,PMHNP- BC
- Suttiwara Viprakasit, MD
- Wade Family Medicine, LLC. (Wade Family Medicine)
- Modeanna Leigh Wade, APRN
- Wal-Mart Stores East LP (Walmart Pharmacy 10-0093)
- Wal-Mart Stores East, LP (Vision Center 30-0093)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.