Active NPI
Jeffrey Carl Fosnes, M.D.
- Specialist
- Springfield, TN
National Provider Identifier
1487609467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MD14905
- Practice address
- 220 Northcrest Dr
Springfield, TN 37172-3962 - Phone
- (615) 598-7633
- Fax
- (931) 762-6532
- NPI assigned
- May 24, 2006
- Last updated
- Nov 20, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MD14905 | TN | Primary |
Addresses
Primary practice location
220 Northcrest Dr
Springfield, TN 37172-3962
Mailing address
220 Northcrest Dr
Springfield, TN 37172-3962
Phone (615) 598-7633
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3000421 | Medicaid | TN | |
| 4103229 | Other | TN | BLUECROSS BLUESHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD14905 | TN | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Springfield Neurology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Neurology Physician
- Bolivar, TN
- NPI 1629408059
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542672000000",
"number": "1487609467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 NORTHCREST DR",
"city": "SPRINGFIELD",
"state": "TN",
"postal_code": "371723962",
"telephone_number": "615-598-7633",
"fax_number": "931-762-6532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 NORTHCREST DR",
"city": "SPRINGFIELD",
"state": "TN",
"postal_code": "371723962",
"telephone_number": "615-598-7633",
"fax_number": "931-762-6532"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOSNES",
"first_name": "JEFFREY",
"middle_name": "CARL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-24",
"last_updated": "2018-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "TN",
"license": "MD14905",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3000421",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD",
"identifier": "4103229",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.