Individual provider Active NPI

Adam Lee Summerlin, M.D.

  • Diagnostic Radiology Physician
  • Jackson, TN
National Provider Identifier
1366686503
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
52582 Issued in TN
Practice address
620 Skyline Dr
Jackson, TN 38301-3923
Phone
(731) 541-6174
Fax
(731) 541-8008
NPI assigned
Apr 30, 2009
Last updated
Apr 28, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

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 52582 TN Primary

Addresses

Primary practice location

620 Skyline Dr
Jackson, TN 38301-3923

Mailing address

PO Box 11955
Jackson, TN 38308-0132
Phone (888) 630-0845

Other identifiers 1

IdentifierTypeStateIssuer
Q014176MedicaidTN

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150826001733 TN Practitioner - Diagnostic Radiology 5395960959 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Alabama School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jackson Clinic PAGroup PAC ID 2668376872, 171 clinicians
Jackson Radiology Associates PAGroup PAC ID 6305893231, 28 clinicians

Practice addresses (Care Compare)

145 Innovation Dr
Jackson, TN 38305-3019
Phone (731) 422-0213

2859 Hwy 45 Byp
Jackson, TN 38305-3618
Phone (731) 664-1375

2863 Hwy 45 Byp
Jackson, TN 38305-3618
Phone (731) 664-1375

620 Skyline Dr
Jackson, TN 38301-3923
Phone (731) 541-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.15 of 100Reported as group
Quality
74.15
Promoting interoperability
77
Improvement activities
40
Cost
78.84

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Imaging of Tennessee CurrentSince May 30, 2019 Accepting new patients
Jackson Clinic PA Diagnostic Radiology CurrentSince Jul 17, 2015 Accepting new patients
Jackson Clinic PA CurrentSince Jul 17, 2015 Accepting new patients
Jackson Radiology Associates PA Diagnostic Radiology CurrentSince Jul 1, 2015 Accepting new patients
Brookwood Womens Diagnostic Center, LLC CurrentSince Jun 1, 2014 Accepting new patients
Jackson Madison County General Hospital Diagnostic Radiology CurrentSince Oct 1, 2025 Accepting new patients

Locations

650 Nuckolls Rd
Bolivar, TN 38008
Phone (731) 541-6834

1700 Woodlawn Ave
Dyersburg, TN 38024
Phone (731) 286-1115

1270 Union University Dr
Ste A
Jackson, TN 38305
Phone (731) 664-0103

17 Centre Plaza Dr
Jackson, TN 38305
Phone (731) 512-0104

244 Coatsland Dr
Jackson, TN 38301
Phone (731) 422-4642

28 Medical Center Dr
Jackson, TN 38301
Phone (731) 427-9971

2863 Highway 45 Byp
Jackson, TN 38305
Phone (731) 660-8300

294 Summar Dr
Jackson, TN 38301
Phone (731) 423-1932

367 Hospital Blvd
Jackson, TN 38305
Phone (731) 661-2000

395 Hospital Blvd
Jackson, TN 38305
Phone (731) 664-7395

620 Skyline Dr
Jackson, TN 38301
Phone (731) 541-4923

700 W Forest Ave
Ste 200
Jackson, TN 38301
Phone (731) 423-1267

86 Stonebridge Blvd
Jackson, TN 38305
Phone (731) 300-0227

87 Murray Guard Dr
Ste B
Jackson, TN 38305
Phone (731) 664-1375

9 Physicians Dr
Jackson, TN 38305
Phone (731) 661-0086

200 W Church St
Lexington, TN 38351
Phone (731) 968-1812

9550 Highway 412 W
Lexington, TN 38351
Phone (731) 967-3224

161 Mount Pelia Rd
Martin, TN 38237
Phone (731) 587-4261

4039 Highland St
Milan, TN 38358
Phone (731) 660-8755

270 E Court Ave
Selmer, TN 38375
Phone (731) 422-0330

Organizations & group practices 6

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.

Hospital & facility affiliations 5

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": "1241049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493337600000",
    "number": "1366686503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11955",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383080132",
            "telephone_number": "888-630-0845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013923",
            "telephone_number": "731-541-6174",
            "fax_number": "731-541-8008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERLIN",
        "first_name": "ADAM",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-30",
        "last_updated": "2017-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TN",
            "license": "52582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q014176",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.