NPIMap

Individual provider Active NPI

Jim Pang Jr., M.D.

  • Psychiatry Physician
  • Cordova, TN
National Provider Identifier
1780690230
Registry record updated Feb 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
017659 Issued in TN
Practice address
65 Germantown CT Ste 402
Cordova, TN 38018-7290
Phone
(901) 752-4900
Fax
(901) 752-4902
NPI assigned
Aug 1, 2006
Last updated
Feb 9, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 9, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X C-5226 AR
Psychiatry Physician 2084P0800X 14059 MS
Geriatric Psychiatry Physician 2084P0805X 2006031057 MO
Psychiatry Physician 2084P0800X 017659 TN Primary

Addresses

Primary practice location

65 Germantown CT Ste 402
Cordova, TN 38018-7290

Mailing address

65 Germantown CT Ste 402
Cordova, TN 38018-7290
Phone (901) 752-4900

Other identifiers 6

IdentifierTypeStateIssuer
0063427OtherTNBLUE CROSS PROVIDER NUMBE
00115350MedicaidMS
02850722MedicaidMS
207980814MedicaidMO
3024414MedicaidTN
127994001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS, AR, MO4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20040913001404 TN Practitioner - Psychiatry 2769459338 Reassigns benefits to 1 organization
I20040928000888 MS Practitioner - Psychiatry 2769459338 Reassigns benefits to 3 organizations
Practice locations: Batesville, MS; Marks, MS; Oxford, MS; Tunica, MS; Tupelo, MS; Water Valley, MS
I20070113000145 AR Practitioner - PsychiatryPractitioner - Neuropsychiatry 2769459338 Reassigns benefits to 1 organization
Receives reassigned benefits from 2 practitioners
Practice locations: Monete, AR; Van Buren, AR; Osceola, AR; Ola, AR; Marion, AR; Marianna, AR; Manila, AR; Helena, AR…
I20070119000370 MO Practitioner - Psychiatry 2769459338 Practice locations: Charleston, MO; Steele, MO; Senath, MO; Scott City, MO; Hayti, MO; Gideon, MO; Cape Girardeau, MO

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Arkansas College of Medicine, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Magnolia Regional Behavioral Health ServicesGroup PAC ID 3375820541, 5 clinicians
Jim Pang MD PLLCGroup PAC ID 4688925696, 11 clinicians
Delta Behavioral Health, LLCGroup PAC ID 6406280007, 6 clinicians

Practice addresses (Care Compare)

611 Alcorn Dr
Corinth, MS 38834-9321
Phone (662) 293-5530

65 Germantown CT
Suite 402
Cordova, TN 38018-4275

8000 Centerview Pkwy
Suite 301
Cordova, TN 38018-4131
Phone 90175249005

8135 Goodman Rd
Olive Branch, MS 38654-2103
Phone 90175249005

920 E Medical Dr
Manila, AR 72442-8416
Phone (870) 570-0358

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C-5226ARMDPsychiatry Physician
14059MSMDPsychiatry Physician
017659TNMDPsychiatry Physician
2006031057MOMDGeriatric Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Magnolia Regional Behavioral Health Services Psychiatry CurrentSince Mar 5, 2020 Accepting new patients
Jim Pang MD PLLC CurrentSince Jan 1, 2018 Accepting new patients
Magnolia Regional Health Center Current Accepting new patients
Delta Behavioral Health, LLC CurrentSince Jan 1, 2020 Accepting new patients
Alliance Healthcare System CurrentSince Jan 29, 2019 Accepting new patients
Alliance Healthcare System Inc Current Accepting new patients
Alliance Healthcare System, Inc CurrentSince Jan 29, 2019 Accepting new patients
Vanderbilt University Past Accepting new patients
Crestpark Helena, LLC Past Accepting new patients
Evergreene Properties of North Carolina,LLC Past Accepting new patients
Evergreene Pproperties of North Carolina,LLC PastSince May 1, 2011 Accepting new patients
Crestpark Marianna, LLC PastSince May 1, 2011 Accepting new patients

Locations

920 Medical Dr
Manila, AR 72442
Phone (870) 570-0358

611 Alcorn Dr
Corinth, MS 38834
Phone (601) 286-6961

1430 Highway 4 E
Holly Springs, MS 38635
Phone (662) 252-1212

8135 Goodman Rd
Olive Branch, MS 38654
Phone (662) 893-7102

65 Germantown Ct
Ste 402
Cordova, TN 38018
Phone (901) 752-4900

8000 Centerview Pkwy
Ste 301
Cordova, TN 38018
Phone (901) 752-4900

Interoperability endpoints

  • Direct secure messaging: jim.pang.1@32437.direct.athenahealth.com
  • Direct secure messaging: jimpang@magnolia.medalliesdirect.net
  • Direct secure messaging: jpang27661@mlh.direct-ci.com

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Organizations & group practices 12

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 3

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581206400000",
    "number": "1780690230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 GERMANTOWN CT STE 402",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380187290",
            "telephone_number": "901-752-4900",
            "fax_number": "901-752-4902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 GERMANTOWN CT STE 402",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380187290",
            "telephone_number": "901-752-4900",
            "fax_number": "901-752-4902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANG",
        "first_name": "JIM",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2020-02-09",
        "certification_date": "2020-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AR",
            "license": "C-5226",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "14059",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "MO",
            "license": "2006031057",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "017659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "0063427",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00115350",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02850722",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207980814",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3024414",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127994001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordova, TN

Sources for this page

Verify at the official NPI Registry.