NPIMap

Individual provider Active NPI

Samuel Walton Fairbrother

  • Diagnostic Radiology Physician
  • Nashville, TN
National Provider Identifier
1346530284
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
56941 Issued in TN
Practice address
210 25TH Ave N Ste 1204
Nashville, TN 37203-1620
Phone
(615) 312-0600
Fax
(615) 320-3259
NPI assigned
Apr 12, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 56941 TN Primary

Addresses

Primary practice location

210 25TH Ave N Ste 1204
Nashville, TN 37203-1620

Mailing address

210 25TH Ave N Ste 1204
Nashville, TN 37203-1620
Phone (615) 312-0600

Other practice location 1

2018 Murphy Ave Ste 200
Nashville, TN 37203-1929
Phone (615) 320-7387

Other practice location 2

4488 Carothers Pkwy Ste 110
Franklin, TN 37067-6584
Phone (615) 721-0935

Other practice location 3

103 Physicians Way Ste 100
Lebanon, TN 37090-4129
Phone (615) 443-7436

Other practice location 4

52 White Bridge Pike
Nashville, TN 37205-1411
Phone (615) 354-1255

Other identifiers 1

IdentifierTypeStateIssuer
Q036873MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180917000574 TN Practitioner - Diagnostic Radiology 7911277926 Reassigns benefits to 5 organizations
I20240108000964 MS Practitioner - Diagnostic Radiology 7911277926 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Mississippi School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SMB Radiology P aGroup PAC ID 9234136060, 22 clinicians

Practice addresses (Care Compare)

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.71 of 100Reported as group
Promoting interoperability
89
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56941TNMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Imaging Alliance Nashville Pet LLC CurrentSince Jul 16, 2018 Accepting new patients
Tennessee Oncology, PLLC Diagnostic Radiology CurrentSince Aug 1, 2019 Accepting new patients
Radiology Alliance PC Diagnostic Radiology CurrentSince Jul 1, 2018 Accepting new patients
Tennessee Oncology PLLC Diagnostic Radiology CurrentSince Aug 1, 2019 Accepting new patients
Lebanon Pet Scan Center, LLC Diagnostic Radiology CurrentSince Jun 1, 2020 Accepting new patients
SMB Radiology P a Diagnostic Radiology CurrentSince Jan 1, 2024 Accepting new patients
Murfreesboro Radiology & Nuclear Medicine Consultants PLLC Diagnostic Radiology CurrentSince Mar 1, 2023 Accepting new patients
Lakeland Radiologists P a Diagnostic Radiology Past Accepting new patients
Tennessee Oncology,PLLC Diagnostic Radiology Past Accepting new patients

Locations

1801 Ashley Cir
Bowling Green, KY 42104
Phone (270) 781-4330

1720A Medical Park Dr
Ste 110
Biloxi, MS 39532
Phone (228) 392-1224

15012 Lemoyne Blvd
Biloxi, MS 39532
Phone (228) 392-5050

14231 Seaway Rd
Ste 5003
Gulfport, MS 39503
Phone (228) 864-4392

15200 Community Rd
Gulfport, MS 39503
Phone (228) 575-7000

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

3109 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 818-1100

3535 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 818-1111

2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000

3101 Denny Ave
Ste 300
Pascagoula, MS 39581
Phone (228) 471-1410

1032 McCallie Ave
Ste 200
Chattanooga, TN 37403
Phone (423) 693-2400

605 Glenwood Dr
Ste 200
Chattanooga, TN 37404
Phone (423) 698-1844

776 Weatherly Dr
Ste A
Clarksville, TN 37043
Phone (931) 906-2004

4488 Carothers Pkwy
Ste 310
Franklin, TN 37067
Phone (615) 986-4330

4488 Carothers Pkwy
Ste 110
Franklin, TN 37067
Phone (615) 320-7387

103 Physicians Way
Ste 100
Lebanon, TN 37090
Phone (615) 443-7436

1700 Medical Center Pkwy
Murfreesboro, TN 37129
Phone (615) 396-4100

2018 Murphy Ave
Ste 200
Nashville, TN 37203
Phone (615) 320-7387

52 White Bridge Pike
Nashville, TN 37205
Phone (615) 354-1255

210 25th Ave N
Ste 1204
Nashville, TN 37203
Phone (615) 312-1479

210 25th Ave N
Ste 602
Nashville, TN 37203
Phone (615) 312-0604

4220 Harding Pike
Ste 101
Nashville, TN 37205
Phone (615) 354-1255

322 22nd Ave N
Ste 140
Nashville, TN 37203
Phone (615) 320-5090

1750 Cedar Ln
Ste 200
Tullahoma, TN 37388
Phone (615) 333-2481

Interoperability endpoints

  • Direct secure messaging: sfairbrother@direct.mhg.com

Organizations & group practices 9

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 64

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 64

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1346530284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 25TH AVE N STE 1204",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031620",
            "telephone_number": "615-312-0600",
            "fax_number": "615-320-3259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 25TH AVE N STE 1204",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031620",
            "telephone_number": "615-312-0600",
            "fax_number": "615-320-3259"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2018 Murphy Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372031929",
            "country_code": "US",
            "telephone_number": "615-320-7387",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4488 Carothers Pkwy Ste 110",
            "address_purpose": "LOCATION",
            "city": "Franklin",
            "state": "TN",
            "postal_code": "370676584",
            "country_code": "US",
            "telephone_number": "615-721-0935",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "103 Physicians Way Ste 100",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "TN",
            "postal_code": "370904129",
            "country_code": "US",
            "telephone_number": "615-443-7436",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "52 White Bridge Pike",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372051411",
            "country_code": "US",
            "telephone_number": "615-354-1255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAIRBROTHER",
        "first_name": "SAMUEL",
        "middle_name": "WALTON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-12",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TN",
            "license": "56941",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q036873",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

Verify at the official NPI Registry.