NPIMap

Individual provider Active NPI

Donald V Tucker, MD

  • Internal Medicine Physician
  • Tullahoma, TN
National Provider Identifier
1487695904
Registry record updated Mar 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD024197 Issued in TN
Practice address
100 William Northern Blvd
Tullahoma, TN 37388-2201
Phone
(931) 454-0492
NPI assigned
Jun 8, 2006
Last updated
Mar 20, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 024197 TN
Internal Medicine Physician 207R00000X MD024197 TN Primary

Addresses

Primary practice location

100 William Northern Blvd
Tullahoma, TN 37388-2201

Mailing address

100 William Northern Blvd
Tullahoma, TN 37388-4754
Phone (931) 454-0489

Other identifiers 1

IdentifierTypeStateIssuer
3832134MedicaidTN

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
I20031114000383 TN Practitioner - Internal MedicinePractitioner - Emergency Medicine 3072427939 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Practice Center of Tullahoma LLCGroup PAC ID 2769640812, 6 clinicians

Practice addresses (Care Compare)

100 William N Blvd
Tullahoma, TN 37388-4754
Phone (931) 454-0489

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions22
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
024197TNMDEmergency Medicine Physician
MD024197TNMDInternal Medicine Physician
24197TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice Center of Tullahoma LLC CurrentSince Mar 1, 2012 Accepting new patients
Tullahoma Immediate Care PC CurrentSince Jan 15, 2012 Accepting new patients

Locations

100 William Northern Blvd
Tullahoma, TN 37388
Phone (931) 454-0489

1210 S Jackson St
Tullahoma, TN 37388
Phone (931) 454-0489

730 Kings Ln
Tullahoma, TN 37388
Phone (931) 393-2121

Organizations & group practices 3

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 10

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": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363737600000",
    "number": "1487695904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WILLIAM NORTHERN BLVD",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373884754",
            "telephone_number": "931-454-0489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WILLIAM NORTHERN BLVD",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882201",
            "telephone_number": "931-454-0492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "DONALD",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2013-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "024197",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD024197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3832134",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tullahoma, TN

Sources for this page

Verify at the official NPI Registry.