Radford Douglas Tanksley, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

030170 Issued in CT

Practice address

111 Salem Tpke
Suite 7
Norwich, CT 06360-6459

Phone

(860) 859-2262

NPI assigned

Feb 9, 2006

Last updated

Aug 18, 2008By the provider in NPPES

Sex

Male

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 CT

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

Specialty

Dermatology

Education

University of Mississippi School of Medicine, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology LLCGroup PAC ID 5092706945, 9 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

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.

• Advanced Dermatology LLC

  • Dermatology Physician
  • Norwich, CT
  • NPI 1609892298
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219017600000",
    "number": "1629041728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 SALEM TPKE",
            "address_2": "SUITE 7",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063606459",
            "telephone_number": "860-859-2262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 SALEM TPKE",
            "address_2": "SUITE 7",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063606459",
            "telephone_number": "860-859-2262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANKSLEY",
        "first_name": "RADFORD",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2008-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CT",
            "license": "030170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "010030170CT02",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00332772",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "030170",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janine D. Sylvia, LPC
• Kathryn Dorothy Szeligowski
• Ahmed I Tahseen
• Desmond Talento, APRN, ACUTE CARE
• Tangible Hope LLC
• Christine Tarallo, LCSW
• Edward M Tarka, D.P.M.
• Jennifer Alice Tattersall, LCSW
• John P Tauro, DO
• Mabel Taveras

• Dermatology Physician in Norwich, CT
• Providers in Norwich, CT by specialty
• Dermatology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.