Individual provider Active NPI

Thomas W Jernigan III, M.D.

  • Surgery Physician
  • Union City, TN
National Provider Identifier
1720025315
Registry record updated Mar 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
35697 Issued in TN
Practice address
1205 Russell St
Union City, TN 38261-5352
Phone
(731) 884-0002
NPI assigned
Jun 1, 2006
Last updated
Mar 16, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 35697 TN Primary

Addresses

Primary practice location

1205 Russell St
Union City, TN 38261-5352

Mailing address

965 Ridge Lake Blvd Ste 103
Memphis, TN 38120-9446

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060503000643 TN Practitioner - General SurgeryPractitioner - Vascular Surgery 8820008980 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Vascular Surgery
Education
University of Tennessee, HSC, College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1205 Russell St
Union City, TN 38261-5352
Phone (731) 884-0002

36 Capital Way
Suite E
Atoka, TN 38004-7986
Phone (901) 837-6801

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.87 of 100Reported as group
Quality
64.75
Promoting interoperability
100
Improvement activities
40
Cost
74.81

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy11
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Mastectomy12
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Varicose vein removal1-10
Melanoma (skin cancer) excision26
Removal of tissue1-10
Removal of skin lesions12
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35697TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Memorial Medical Group Inc Surgery CurrentSince Aug 1, 2019 Accepting new patients
Baptist Memorial Medical Group Inc CurrentSince Aug 1, 2019 Accepting new patients

Locations

36 Capital Way
Ste E
Atoka, TN 38004
Phone (901) 837-6801

1205 Russell St
Union City, TN 38261
Phone (731) 644-3211

Interoperability endpoints

  • Direct secure messaging: tjernigan12729@direct.bmhcc.org

Organizations & group practices 3

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 1

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584316800000",
    "number": "1720025315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 RIDGE LAKE BLVD STE 103",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209446",
            "fax_number": "901-227-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 RUSSELL ST",
            "city": "UNION CITY",
            "state": "TN",
            "postal_code": "382615352",
            "telephone_number": "731-884-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERNIGAN",
        "first_name": "THOMAS",
        "middle_name": "W",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "35697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union City, TN

Sources for this page

Verify at the official NPI Registry.