Daisy Tan Antique, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

39516 Issued in TN

Practice address

708 W Forest Ave
Jackson, TN 38301-3901

Phone

(731) 660-8759

Fax

(731) 660-8739

NPI assigned

Mar 2, 2006

Last updated

Dec 11, 2007By the provider in NPPES

Sex

Female

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 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• West Tennessee Healthcare Hospitalists Inc

  • Hospitalist Physician
  • Jackson, TN
  • NPI 1720635188
  Medicare reassignment NPD
• Jackson Madison County General Hospital

  • General Practice Physician
  • Jackson, TN
  • NPI 1467493916

  Internal Medicine

  NPD (past)
• West Tennessee Medical Group Inc

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1053615955
  NPD (past)

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197331200000",
    "number": "1447227939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 HIGHWAY 45 BYP",
            "address_2": "SUITE 604",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054436",
            "telephone_number": "731-660-8759",
            "fax_number": "731-660-8739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 W FOREST AVE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013901",
            "telephone_number": "731-660-8759",
            "fax_number": "731-660-8739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTIQUE",
        "first_name": "DAISY",
        "middle_name": "TAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-02",
        "last_updated": "2007-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "39516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00364407",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3337042",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4118140",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rhiannon Michelle Andresen, FNP-C
• William Farr Andrews Jr., DDS
• Anesthesia Services Associates, PLLC
• Laila Annamer
• Brittany Alexis Anthony
• Julie Tan Antique, MD
• Maria Caroline Antique, M.D.
• Michael Thomas Anton, PSY.D.
• Harold M Antwine, MD
• Anu Counseling and Services LLC

• Internal Medicine Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.