Individual provider Active NPI

Marvyn L Hegmon, LCSW

  • Clinical Social Worker
  • Jackson, TN
National Provider Identifier
1790720480
Registry record updated May 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1022 Issued in TN
Practice address
238 Summar Dr
Jackson, TN 38301-3906
Phone
(731) 935-8200
Fax
(731) 935-8327
NPI assigned
Jun 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 1022 TN Primary
Social Worker 104100000X 1022 TN

Addresses

Primary practice location

238 Summar Dr
Jackson, TN 38301-3906

Mailing address

1804 Highway 45 Byp
Ste 604
Jackson, TN 38305-4436
Phone (731) 660-8755

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110224000245 TN Practitioner - Clinical Social Worker 9335320340 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1022TNMDHearing Instrument Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Pathways of Tennessee, Inc. CurrentSince Oct 1, 2000 Accepting new patients

Locations

1804 Highway 45 Byp
Ste 216
Jackson, TN 38305
Phone (731) 664-6327

238 Summar Dr
Jackson, TN 38301
Phone (731) 541-8200

9550 Highway 412 W
Ste B
Lexington, TN 38351
Phone (731) 968-8197

930 Mount Zion Rd
Union City, TN 38261
Phone (731) 885-9333

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336608000000",
    "number": "1790720480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 HIGHWAY 45 BYP",
            "address_2": "STE 604",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054436",
            "telephone_number": "731-660-8755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 SUMMAR DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013906",
            "telephone_number": "731-935-8200",
            "fax_number": "731-935-8327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEGMON",
        "first_name": "MARVYN",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2012-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "1022",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TN",
            "license": "1022",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.