NPIMap

Organization Active NPI

Roger O. Gibson MD PC

  • Internal Medicine Physician
  • Cordova, TN
National Provider Identifier
1386836062
Registry record updated Nov 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
10277 Issued in TN
Legal business name
ROGER O. GIBSON MD PC
Practice address
295 Germantown Bend CV
Cordova, TN 38018-7238
Phone
(901) 751-0150
Fax
(901) 695-2007
NPI assigned
Aug 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2024

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

Authorized official

Name
Dr. Roger O. Gibson, M. D.NPI 1316930704
Title
President
Phone
(901) 751-0150

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 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 1

IdentifierTypeStateIssuer
08560OtherMSSTATE OF MISSISSIPPI BOARD OF LICENSE REGISTRATION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110105000348 TN Part B Supplier - Clinic/Group Practice 2163611260 Receives reassigned benefits from 1 practitioner
Practice locations: Cordova, TN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1187136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731628800000",
    "number": "1386836062",
    "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": {
        "organization_name": "ROGER O. GIBSON MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-15",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-751-0150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "10277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MISSISSIPPI BOARD OF LICENSE REGISTRATION",
            "identifier": "08560",
            "state": "MS"
        }
    ],
    "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.