Individual provider Active NPI

Brian Richard Decosta, M.D.

  • Diagnostic Radiology Physician
  • Jackson, TN
National Provider Identifier
1689620627
Registry record updated May 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
36602 Issued in TN
Practice address
367 Hospital Blvd
Jackson, TN 38305-2080
Phone
(731) 300-0352
Fax
(901) 753-2896
NPI assigned
May 25, 2006
Last updated
May 6, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 36602 TN Primary

Addresses

Primary practice location

367 Hospital Blvd
Jackson, TN 38305-2080

Mailing address

PO Box 11686
Jackson, TN 38308-0128
Phone (731) 300-0352

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, AR, MS3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20040930000935 TN Practitioner - Diagnostic Radiology 0143299610 Reassigns benefits to 4 organizations
I20230525002327 AR Practitioner - Diagnostic Radiology 0143299610 Reassigns benefits to 3 organizations
I20230621003089 MS Practitioner - Diagnostic Radiology 0143299610 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid-South Imaging and Therapeutics, P.a.Group PAC ID 9133106396, 69 clinicians

Practice addresses (Care Compare)

4800 E Johnson Ave
Jonesboro, AR 72405-8413
Phone (870) 936-0140

7600 Wolf River Blvd
Suite 200
Germantown, TN 38138-1788
Phone (901) 747-1000

7601 Southcrest Pkwy
Southaven, MS 38671-4739
Phone (901) 383-9478

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75.65 of 100Reported as group
Quality
44.87
Promoting interoperability
100
Improvement activities
40
Cost
73.98

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36602TNMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Imaging of Tennessee CurrentSince May 30, 2019 Accepting new patients
Memphis Physicians Radiological Group PC Diagnostic Radiology CurrentSince Jan 1, 2023 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Jul 10, 2023 Accepting new patients
Jackson Radiology Associates PA Diagnostic Radiology CurrentSince May 1, 2018 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Current Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. CurrentSince Jul 10, 2023 Accepting new patients
West Tennessee Imaging, LLC Diagnostic Radiology CurrentSince May 1, 2023 Accepting new patients

Locations

1111 Windover Rd
Jonesboro, AR 72401
Phone (870) 935-5432

4800 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 732-2100

900 W Kingshighway
Paragould, AR 72450
Phone (870) 239-7000

10 Little Brook Rd
West Wareham, MA 02576

650 Nuckolls Rd
Bolivar, TN 38008
Phone (731) 541-6834

367 Hospital Blvd
Jackson, TN 38305
Phone (731) 661-2000

620 Skyline Dr
Jackson, TN 38301
Phone (731) 541-4923

200 W Church St
Lexington, TN 38351
Phone (731) 968-1812

5959 Park Ave
Memphis, TN 38119
Phone (901) 765-1000

6019 Walnut Grove Rd
Memphis, TN 38120
Phone (901) 226-3190

7600 Wolf River Blvd
Memphis, TN 38138
Phone (615) 550-6049

7600 Wolf River Blvd
Ste 100
Memphis, TN 38138
Phone (901) 312-4033

7600 Wolf River Blvd
Ste 200
Memphis, TN 38138
Phone (901) 747-1000

Organizations & group practices 8

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 5

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399334400000",
    "number": "1689620627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11686",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383080128",
            "telephone_number": "731-300-0352",
            "fax_number": "901-753-2896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 HOSPITAL BLVD",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052080",
            "telephone_number": "731-300-0352",
            "fax_number": "901-753-2896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECOSTA",
        "first_name": "BRIAN",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2014-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TN",
            "license": "36602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.