Individual provider Active NPI

Mark Fellows Weems, M.D.

  • Neonatal-Perinatal Medicine Physician
  • Memphis, TN
National Provider Identifier
1477793362
Registry record updated Feb 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
50174 Issued in TN
Practice address
853 Jefferson Ave
Rout BLDG E201
Memphis, TN 38103-2807
Phone
(901) 448-5950
NPI assigned
Mar 4, 2009
Last updated
Feb 25, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A106872 CA
Neonatal-Perinatal Medicine Physician 2080N0001X A106872 CA
Neonatal-Perinatal Medicine Physician 2080N0001X 50174 TN Primary

Addresses

Primary practice location

853 Jefferson Ave
Rout BLDG E201
Memphis, TN 38103-2807

Mailing address

1068 Cresthaven Rd Ste 300
Memphis, TN 38119-0809

Other identifiers 3

IdentifierTypeStateIssuer
198061001MedicaidAR
04328790MedicaidMS
1533405MedicaidTN

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
I20130807000593 TN Practitioner - Pediatric Medicine 9133361942 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A106872CAMDPediatrics Physician
50174TNMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Medical Group, Inc. CurrentSince Sep 1, 2013 Accepting new patients
Ut Medical Group Inc Neonatal-Perinatal Medicine CurrentSince Sep 1, 2013 Accepting new patients

Locations

1068 Cresthaven Rd
Ste 300
Memphis, TN 38119
Phone (901) 683-0024

1407 Union Ave
Ste 700
Memphis, TN 38104
Phone (901) 866-8360

853 Jefferson Ave
Ste 201
Memphis, TN 38103
Phone (901) 448-4750

930 Madison Ave
Ste 200
Memphis, TN 38103
Phone (901) 448-6650

Interoperability endpoints

  • Direct secure messaging: mweems31134@mlh.direct-ci.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1236124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740441600000",
    "number": "1477793362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1068 CRESTHAVEN RD STE 300",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381190809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 JEFFERSON AVE",
            "address_2": "ROUT BLDG E201",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381032807",
            "telephone_number": "901-448-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEEMS",
        "first_name": "MARK",
        "middle_name": "FELLOWS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-04",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A106872",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "CA",
            "license": "A106872",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "TN",
            "license": "50174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "198061001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04328790",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1533405",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.