Active NPI
Roger O. Gibson, M. D.
- Internal Medicine Physician
- Cordova, TN
National Provider Identifier
1316930704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 10277
- Practice address
- 295 Germantown Bend CV
Cordova, TN 38018-7238 - Phone
- (901) 751-0150
- Fax
- (901) 695-2007
- NPI assigned
- Aug 31, 2005
- Last updated
- Nov 15, 2024
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 10277 | TN | Primary |
Addresses
Primary practice location
295 Germantown Bend CV
Cordova, TN 38018-7238
Mailing address
295 Germantown Bend CV
Cordova, TN 38018-7238
Phone (901) 751-0150
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 44D0314829 | Other | TN | CLIA |
| 2006851 | Other | TN | BLUE CROSS OF TENNESSEE |
| 3382574 | Medicaid | TN | |
| 10277 | Other | TN | TN MEDICAL LICENSE |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- University of Tennessee, HSC, College of Medicine, 1976
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
295 Germantown Bend CV
Cordova, TN 38018-7238
Phone (901) 751-0150
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10277 | TN | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roger O. Gibson MD PC | Internal Medicine | Current | Accepting new patients |
| Dietitian Associates, Inc. | Current | Accepting new patients |
Locations
295 Germantown Bend Cv
Cordova, TN 38018
Phone (901) 751-0150
1374 Cordova Cv
Ste 102
Memphis, TN 38138
Phone (901) 683-3188
Interoperability endpoints
- rgibson32142@mlh.direct-ci.com
Organizations & group practices 2
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.
-
- Internal Medicine Physician
- Cordova, TN
- NPI 1386836062
-
- Registered Dietitian
- Nesbit, MS
- NPI 1598794497
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Memphis, TN
- NPI 1578527172
-
dba Le Bonheur Children's Hospital
- Children's Hospital
- Memphis, TN
- NPI 1386709871
-
- General Acute Care Hospital
- Memphis, TN
- NPI 1558365890
-
dba Le Bonheur Children's Hospital - Germantown
- Children's Hospital
- Germantown, TN
- NPI 1649654450
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731628800000",
"number": "1316930704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "295 GERMANTOWN BEND CV",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380187238",
"telephone_number": "901-751-0150",
"fax_number": "901-695-2007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "295 GERMANTOWN BEND CV",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380187238",
"telephone_number": "901-751-0150",
"fax_number": "901-695-2007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "ROGER",
"middle_name": "O.",
"name_prefix": "Dr.",
"credential": "M. D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-31",
"last_updated": "2024-11-15",
"certification_date": "2024-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "TN",
"license": "10277",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA",
"identifier": "44D0314829",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF TENNESSEE",
"identifier": "2006851",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3382574",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TN MEDICAL LICENSE",
"identifier": "10277",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cordova, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.