Justin B Tucker, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2280 Issued in TN

Practice address

6799 Great Oaks Rd Ste 100
Memphis, TN 38138-2571

Phone

(901) 751-0405

Fax

(901) 751-9694

NPI assigned

Dec 6, 2012

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 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Cherokee Health Systems

  • Federally Qualified Health Center (FQHC)
  • Talbott, TN
  • NPI 1134128820

  TN

  Medicare reassignment NPD
• Consolidated Medical Practices of Memphis,PLLC

  • Internal Medicine Physician
  • Memphis, TN
  • NPI 1508027491

  TN

  Medicare reassignment
• Cherokee Health Systems

  • Federally Qualified Health Center (FQHC)
  • White Pine, TN
  • NPI 1699666404
  NPD
• Cane Ridge Emergency Physicians LLC

  • Emergency Medicine Physician
  • Smyrna, TN
  • NPI 1275815433
  NPD (past)
• Memphis Cardiovascular Center

  • Cardiovascular Disease Physician
  • Memphis, TN
  • NPI 1063873909
  NPD (past)

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

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508889600000",
    "number": "1669717328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6799 GREAT OAKS RD STE 100",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381382571",
            "telephone_number": "901-751-0405",
            "fax_number": "901-751-9694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6799 GREAT OAKS RD STE 100",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381382571",
            "telephone_number": "901-751-0405",
            "fax_number": "901-751-9694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4095 American Way",
            "address_2": "Suite 1",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381188339",
            "country_code": "US",
            "telephone_number": "901-271-9500",
            "fax_number": "901-271-9501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "JUSTIN",
        "middle_name": "B",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-06",
        "last_updated": "2017-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q000691",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Tucker-Talbert
• Carla Marie Tucker
• Drew Alan Tucker, DPT
• Elaine Tucker
• Erin Tucker
• Kimberly Rochelle Brown Tucker, FNP
• Leonard Tucker III, PTA
• Ranesha Tucker
• Renwick Eddie Tucker, D.C.
• Tiffany Tucker, PHD

• All providers in Memphis, TN
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.