Clifton Tatum, MD

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

26863 Issued in KY

Practice address

200 E Gray St
Louisville, KY 40202-2012

Phone

(502) 629-7601

NPI assigned

Jul 11, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Open MRI, LLC

  • Body Imaging Physician
  • Louisville, KY
  • NPI 1770550550
  NPD (past)
• Kentuckiana Diagnostics

  • Diagnostic Radiology Physician
  • Jeffersonville, IN
  • NPI 1225030901
  NPD (past)

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359072000000",
    "number": "1366440687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 E GRAY ST",
            "address_2": "SUITE 850",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021900",
            "telephone_number": "502-585-1735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E GRAY ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402022012",
            "telephone_number": "502-629-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATUM",
        "first_name": "CLIFTON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2013-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "KY",
            "license": "26863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100356810A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "1052796",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50005985",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64268634",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "000000308613",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "000000050041",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan S.B. Tate, M.D.
• Taylor Lauren Tate, COTA/L
• Vera Tate, M.D.
• Omar Tattan
• Brittney Tatum
• Robert R Tatum, PA-C
• Tatyanas Case Management, LLC
• Tatyanas Case Management, LLC
• Tatyanas Case Management, LLC
• Tatyanas Case Management, LLC

• Vascular & Interventional Radiology Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Vascular & Interventional Radiology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.