NPIMap

Individual provider Active NPI

Brian S Waggoner, MD

  • Internal Medicine Physician
  • Cookeville, TN
National Provider Identifier
1255331914
Registry record updated Jul 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD27530 Issued in TN
Practice address
428 N Willow Ave
Cookeville, TN 38501-2339
Phone
(931) 854-9988
Fax
(931) 854-9977
NPI assigned
Jul 26, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2016

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 MD27530 TN Primary

Addresses

Primary practice location

428 N Willow Ave
Cookeville, TN 38501-2339

Mailing address

428 N Willow Ave
Cookeville, TN 38501-2339
Phone (931) 854-9988

Other identifiers 2

IdentifierTypeStateIssuer
4033875OtherTNBLUE CROSS BLUE SHIELD
3812970MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031122000018 TN Practitioner - Internal Medicine 5092619841 Practice locations: Cookeville, TN

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Washington University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

428 N Willow Ave
Cookeville, TN 38501-2339
Phone 93185499882

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
22.41 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
74.69

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD27530TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Audrey Karen Tolbert Internal Medicine 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.

Hospital & facility affiliations 11

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": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468454400000",
    "number": "1255331914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 N WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012339",
            "telephone_number": "931-854-9988",
            "fax_number": "931-854-9977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 N WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012339",
            "telephone_number": "931-854-9988",
            "fax_number": "931-854-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "BRIAN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-26",
        "last_updated": "2016-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD27530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4033875",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3812970",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.