Melvin Sisco, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1103472 Issued in TN

Practice address

575 Oak Ridge Tpke
Suite 120
Oak Ridge, TN 37830-7100

Phone

(865) 483-5678

Fax

(865) 483-4027

NPI assigned

Apr 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

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

Physician Assistant

State licenses

Practice roles

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.

• Southeastern Emergency Services P C

  • Nurse Practitioner
  • Athens, TN
  • NPI 1669414264
  Medicare reassignment
• Kids Central Pediatrics, Inc.

  • Primary Care Clinic/Center
  • Oak Ridge, TN
  • NPI 1609906676
  NPD (past)

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

{
    "created_epoch": "1333670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333670400000",
    "number": "1669738431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 OAK RIDGE TPKE",
            "address_2": "SUITE 120",
            "city": "OAK RIDGE",
            "state": "TN",
            "postal_code": "378307100",
            "telephone_number": "865-483-5678",
            "fax_number": "865-483-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 OAK RIDGE TPKE",
            "address_2": "SUITE 120",
            "city": "OAK RIDGE",
            "state": "TN",
            "postal_code": "378307100",
            "telephone_number": "865-483-5678",
            "fax_number": "865-483-4027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISCO",
        "first_name": "MELVIN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-06",
        "last_updated": "2012-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "1103472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley K Silcox
• Gwen Margrave Simmons, RPH
• Robert L. Simpson
• Wesley Wayne Singer, DDS
• Ashutosh Singh, M.D.
• Carrie S. Sitz
• Jennifer Skero, FNP
• Sleep Well East Tennessee PLLC
• Lee Alan Smalley, MD
• Garrison James Smith, DO

• Physician Assistant in Oak Ridge, TN
• Providers in Oak Ridge, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2012; 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.