Robert W Tucker, PA

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

002765 Issued in GA

Practice address

218 Quarterman Street
Waycross, GA 31501-3547

Phone

(912) 287-0301

Fax

(912) 287-1568

NPI assigned

Feb 16, 2006

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 2

Medicare fee-for-service enrollment

Enrolled in GA

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

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.

• Phoebe Putney Memorial Hospital Inc

  • General Acute Care Hospital
  • Albany, GA
  • NPI 1992789721
  Medicare reassignment NPD
• Phoebe Sumter Medical Center, Inc.

  • General Acute Care Hospital
  • Americus, GA
  • NPI 1609001312
  Medicare reassignment NPD
• Phoebe Putney Memorial Hospital Inc

  • Community/Retail Pharmacy
  • Albany, GA
  • NPI 1891315420
  NPD
• Darling Emergency Physicians LLC

  • Emergency Medicine Physician
  • Waycross, GA
  • NPI 1306058573
  NPD (past)
• Mayo Clinic Health System in Waycross, Inc.

  • Multi-Specialty Clinic/Center
  • Waycross, GA
  • NPI 1154745982
  NPD (past)

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

{
    "created_epoch": "1140048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254268800000",
    "number": "1710951595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 QUARTERMAN STREET",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315013547",
            "telephone_number": "912-287-0301",
            "fax_number": "912-287-1568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 QUARTERMAN STREET",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315013547",
            "telephone_number": "912-287-0301",
            "fax_number": "912-287-1568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "ROBERT",
        "middle_name": "W",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-16",
        "last_updated": "2009-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "002765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002789B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002789C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trimed Advance Health, LLC
• Brian Trissell, MD
• Lucinda Trotter, RN
• Trumbalt Dynamics LLC
• Dale Tucker, MD
• Lauren Carden Turner
• Tiffany Denise Tyler
• Kennon Latrell Tyre III, PHARM.D.
• Mitzi Braddock Tyre, FNP
• Uchenna Ukoha

• Emergency Medicine Physician in Waycross, GA
• Providers in Waycross, GA by specialty
• Emergency Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; 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.