Andrew Hayward Lundberg, M.D.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

MD29285 Issued in TN

Practice address

235 Tyson Ave
Paris, TN 38242-4544

Phone

(731) 644-3211

Fax

(731) 644-1552

NPI assigned

Jul 14, 2006

Last updated

Nov 5, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TN, KY2 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 2

Specialty

Vascular Surgery

Education

Wake Forest University School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pinelake Physician Practice LLCGroup PAC ID 6800797507, 45 clinicians

Paris Surgical Specialists PLLCGroup PAC ID 3274525092, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• West Tennessee Healthcare Henry County Hospital Hospital, Paris, TN, CCN 440132
• Jackson Purchase Medical Center Hospital, Mayfield, KY, CCN 180116
• Baptist Memorial Hospital Union City Hospital, Union City, TN, CCN 440130

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: andrew.lundberg.1@19475.direct.athenahealth.com

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.

• Paris Surgical Specialists, P.L.L.C.

  • Surgery Physician
  • Paris, TN
  • NPI 1790701654
  Medicare reassignment Care Compare group NPD
• Pinelake Physician Practice, LLC

  • Rural Health Clinic/Center
  • Mayfield, KY
  • NPI 1295960532
  Medicare reassignment Care Compare group NPD
• Southern Pain and Regenerative Medicine PC

  • Interventional Pain Medicine Physician
  • Olive Branch, MS
  • NPI 1841799707

  TN

  Medicare reassignment NPD
• Bluff City Pain, PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Memphis, TN
  • NPI 1790651263
  NPD
• Pinelake Physician Practice, LLC

  • Rural Health Clinic/Center
  • Mayfield, KY
  • NPI 1841900347
  NPD
• Pinelake Physician Practice, LLC

  dba Jackson Purchase Podiatry

  • Internal Medicine Physician
  • Mayfield, KY
  • NPI 1861563439

  Surgery

  NPD
• West Tennessee Healthcare Henry County

  dba West Tennessee Healthcare County Hospital

  • General Acute Care Hospital
  • Paris, TN
  • NPI 1497750244
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Memorial Hospital- Union City Inc

  • General Acute Care Hospital
  • Union City, TN
  • NPI 1114981768
  Care Compare affiliation
• West Tennessee Healthcare Henry County

  dba West Tennessee Healthcare County Hospital

  • General Acute Care Hospital
  • Paris, TN
  • NPI 1497750244
  Care Compare affiliation
• Pinelake Regional Hospital LLC

  dba Jackson Purchase Medical Center

  • Rural Acute Care Hospital
  • Mayfield, KY
  • NPI 1891892741
  Care Compare affiliation

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194220800000",
    "number": "1770509705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 TYSON AVE",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382424544",
            "telephone_number": "731-644-3211",
            "fax_number": "731-644-1552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 TYSON AVE",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382424544",
            "telephone_number": "731-644-3211",
            "fax_number": "731-644-1552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUNDBERG",
        "first_name": "ANDREW",
        "middle_name": "HAYWARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2007-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "MD29285",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "TN",
            "license": "MD29285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD NUMBR",
            "identifier": "4075410",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "DB4003",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE INDIVID",
            "identifier": "P00113129",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3881424",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Loden Vision Center of Paris, PLC
• Cynthia Gayle Loines, MSN-CRNA
• David H Long, DPM
• Adalberto Jovan Lopez Bonet, PHARMD
• Emily Kay Lowe, OTR/L
• Christian Paige Lundberg, FNP
• Bianca Elizabeth Macdonald, NP
• Annie Kathryn Massey, PA-C
• Emmalee C Mathews, PA
• Dale Mathis

• Vascular Surgery Physician in Paris, TN
• Providers in Paris, TN by specialty
• Vascular Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.