Individual provider Active NPI

Jimmy Russell Carroll Jr., M.D.

  • Diagnostic Radiology Physician
  • Germantown, TN
National Provider Identifier
1477796241
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD0000048405 Issued in TN
Practice address
7600 Wolf River Blvd Ste 200
Germantown, TN 38138-1788
Phone
(901) 747-1000
Fax
(901) 747-1001
NPI assigned
Apr 9, 2009
Last updated
Feb 1, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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 MD0000048405 TN Primary

Addresses

Primary practice location

7600 Wolf River Blvd Ste 200
Germantown, TN 38138-1788

Mailing address

7600 Wolf River Blvd Ste 200
Germantown, TN 38138-1788
Phone (901) 747-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, TN, MS3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20140825000655 AR Practitioner - Diagnostic Radiology 1850523325 Reassigns benefits to 2 organizations
I20150625002438 TN Practitioner - Diagnostic Radiology 1850523325 Reassigns benefits to 2 organizations
I20200331001111 MS Practitioner - Diagnostic Radiology 1850523325 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Tennessee, HSC, College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid-South Imaging and Therapeutics, P.a.Group PAC ID 9133106396, 69 clinicians
West Tennessee Imaging LLCGroup PAC ID 3173834215, 37 clinicians

Practice addresses (Care Compare)

4800 E Johnson Ave
Jonesboro, AR 72405-8413
Phone (870) 936-0140

7600 Wolf River Blvd
Germantown, TN 38138-1785
Phone (901) 312-4033

7600 Wolf River Blvd
Suite 200
Germantown, TN 38138-1788
Phone (901) 747-1000

7601 Southcrest Pkwy
Southaven, MS 38671-4739
Phone (901) 383-9478

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75.65 of 100Reported as group
Quality
44.87
Promoting interoperability
100
Improvement activities
40
Cost
73.98

Merit-based Incentive Payment System (MIPS)

Final score
79.05 of 100Reported as individual
Quality
95
Improvement activities
0
Cost
80.65

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD0000048405TNMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Jul 1, 2014 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Current Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Jul 1, 2014 Accepting new patients
West Tennessee Imaging, LLC Diagnostic Radiology CurrentSince Jan 13, 2020 Accepting new patients
USA Radiology of Pennsylvania, LLC Past Accepting new patients

Locations

1111 Windover Rd
Jonesboro, AR 72401
Phone (870) 935-5432

4800 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 732-2100

4802 E Johnson Ave
Jonesboro, AR 72405
Phone (901) 227-9820

7600 Wolf River Blvd
Memphis, TN 38138
Phone (615) 550-6049

7600 Wolf River Blvd
Ste 100
Memphis, TN 38138
Phone (901) 312-4033

7600 Wolf River Blvd
Ste 200
Memphis, TN 38138
Phone (901) 747-1000

Interoperability endpoints

  • Direct secure messaging: jcarroll15651@direct.bmhcc.org

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": "1239235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1477796241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7600 WOLF RIVER BLVD STE 200",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381381788",
            "telephone_number": "901-747-1000",
            "fax_number": "901-747-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 WOLF RIVER BLVD STE 200",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381381788",
            "telephone_number": "901-747-1000",
            "fax_number": "901-747-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JIMMY",
        "middle_name": "RUSSELL",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-09",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TN",
            "license": "MD0000048405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, TN

Sources for this page

Verify at the official NPI Registry.