NPIMap

Individual provider Active NPI

Garry Wayne Burks, PA

  • Medical Physician Assistant
  • Clarkrange, TN
National Provider Identifier
1407866387
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA454 Issued in TN
Practice address
6845 S York Hwy
Clarkrange, TN 38553-5154
Phone
(931) 863-5095
Fax
(931) 863-3530
NPI assigned
Aug 9, 2006
Last updated
Mar 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA454 TN Primary

Addresses

Primary practice location

6845 S York Hwy
Clarkrange, TN 38553-5154

Mailing address

PO Box 2861
Crossville, TN 38557-2861
Phone (931) 863-5095

Other practice location 1

100 S Duncan St
Jamestown, TN 38556-3009
Phone (931) 879-5864

Other identifiers 1

IdentifierTypeStateIssuer
3104164OtherTNBLUE CROSS BLUE SHEILD TN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090608000431 TN Practitioner - Physician Assistant 1658421946 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Acute Care Clinics of America, LLCGroup PAC ID 6305273392, 8 clinicians

Practice addresses (Care Compare)

100 S Duncan St
Jamestown, TN 38556-3009
Phone (931) 879-5864

6845 S York Hwy
Clarkrange, TN 38553-5154
Phone (931) 863-5095

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.1 of 100Reported as apm
Quality
65.16
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
454TNMDOccupational Therapist
PA454TNMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Clarkrange Clinic LLC Current Accepting new patients
Copeland Medical Services Current Accepting new patients
Ambulatory Care Center of Wartburg Primary Care LLC Current Accepting new patients
Cumberland Spine & Sport, LLC Past Accepting new patients
Cumberland River Hospital Inc Past Accepting new patients
Scott County Community Hospital, Inc. Past Accepting new patients

Locations

110 Doctors Dr
Celina, TN 38551
Phone (931) 243-3860

6845 S York Hwy
Clarkrange, TN 38553
Phone (931) 863-3323

2497 S Roane St
Ste 110
Harriman, TN 37748
Phone (865) 599-0300

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, 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": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1407866387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2861",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385572861",
            "telephone_number": "931-863-5095",
            "fax_number": "931-863-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6845 S YORK HWY",
            "city": "CLARKRANGE",
            "state": "TN",
            "postal_code": "385535154",
            "telephone_number": "931-863-5095",
            "fax_number": "931-863-3530"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 S Duncan St",
            "address_purpose": "LOCATION",
            "city": "Jamestown",
            "state": "TN",
            "postal_code": "385563009",
            "country_code": "US",
            "telephone_number": "931-879-5864",
            "fax_number": "931-879-3903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURKS",
        "first_name": "GARRY",
        "middle_name": "WAYNE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "PA454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD TN",
            "identifier": "3104164",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarkrange, TN

Sources for this page

Verify at the official NPI Registry.