NPIMap

Individual provider Active NPI

Oakley C Jordan, M.D.

  • Internal Medicine Physician
  • Memphis, TN
National Provider Identifier
1750340063
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
11264 Issued in TN
Practice address
740 Bartlett Rd
Memphis, TN 38122-3004
Phone
(901) 685-8202
Fax
(901) 682-3525
NPI assigned
Mar 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 11264 TN Primary

Addresses

Primary practice location

740 Bartlett Rd
Memphis, TN 38122-3004

Mailing address

764 Walnut Knoll LN
Cordova, TN 38018-3113
Phone (901) 756-5565

Other practice location 1

3473 Poplar Ave
Suite 103
Memphis, TN 38111-4654
Phone (901) 320-9615

Other identifiers 3

IdentifierTypeStateIssuer
3165838MedicaidTN
4303405OtherTNBCBS
P00982977OtherTNRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211222000534 MO Practitioner - Internal Medicine 4486651056 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pemiscot County Memorial HospitalGroup PAC ID 8426024159, shared by 8 NPIs, 22 clinicians

Practice addresses (Care Compare)

106 W 12TH St
Caruthersville, MO 63830-1890
Phone (573) 333-1782

907 E Reed St
Hayti, MO 63851-1242
Phone (573) 359-3660

946 E Reed St
Hayti, MO 63851-1243

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11264TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pemiscot County Memorial Hospital CurrentSince Dec 15, 2021 Accepting new patients
Pemiscot County Memorial Hospital CurrentSince Dec 15, 2021 Accepting new patients
Pemiscot County Memorial Hospital Current Accepting new patients
Pemiscot County Memorial Hospital CurrentSince May 1, 2025 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Mid-Town Internal Medicine, PLLC Internal Medicine PastSince May 1, 2001 Accepting new patients
Pemiscot County Memorial Hospital Past Accepting new patients
Methodist Healthcare - Memphis Hospitals Past Accepting new patients

Locations

946 E Reed St
Hayti, MO 63851
Phone (573) 359-3408

907 E Reed St
Hayti, MO 63851
Phone (573) 359-3230

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1750340063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "764 WALNUT KNOLL LN",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380183113",
            "telephone_number": "901-756-5565",
            "fax_number": "901-756-5564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 BARTLETT RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381223004",
            "telephone_number": "901-685-8202",
            "fax_number": "901-682-3525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3473 Poplar Ave",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381114654",
            "country_code": "US",
            "telephone_number": "901-320-9615",
            "fax_number": "901-320-6920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "OAKLEY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "11264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3165838",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4303405",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00982977",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.