Individual provider Active NPI

Carolyn Ruth Marcum, NP

  • Family Nurse Practitioner
  • Memphis, TN
National Provider Identifier
1801067251
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN13353 Issued in TN
Practice address
5865 Rideway Center Parkway
Memphis, TN 38120-3812
Phone
(337) 991-9276
Fax
(337) 943-0846
NPI assigned
Mar 13, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 13353 TN
Nurse Practitioner 363L00000X A810297 MS
Family Nurse Practitioner 363LF0000X APN13353 TN Primary
Registered Nurse 163W00000X 141621 TN

Addresses

Primary practice location

5865 Rideway Center Parkway
Memphis, TN 38120-3812

Mailing address

1509 Dulles Dr
Lafayette, LA 70506-3718
Phone (337) 991-9276

Other practice location 1

100 N Humphreys Blvd
Memphis, TN 38120-2146
Phone (901) 683-0055

Other identifiers 5

IdentifierTypeStateIssuer
00927745MedicaidMS
4182890OtherTNTN BCBS
3341699MedicaidTN
168400758MedicaidAR
1801067251OtherARAR BCBS

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080429000510 TN Practitioner - Nurse Practitioner 3476631656 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
141621TNMDRegistered Nurse
A810297MSMDNurse Practitioner
13353TNMDNurse Practitioner
APN13353TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Curana Health of Tennessee LLC Nurse Practitioner CurrentSince Aug 1, 2015 Accepting new patients

Locations

1509 Dulles Dr
Lafayette, LA 70506
Phone (337) 408-0803

955 N Germantown Pkwy
Cordova, TN 38018
Phone (901) 754-1393

5865 Ridgeway Center Pkwy
Memphis, TN 38120
Phone (901) 219-1295

100 Peabody Pl
Ste 150
Memphis, TN 38103

9155 Crestwyn Hills Dr
Memphis, TN 38125
Phone (901) 261-4848

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": "1205366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1801067251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 DULLES DR",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705063718",
            "telephone_number": "337-991-9276",
            "fax_number": "337-943-0846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5865 RIDEWAY CENTER PARKWAY",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381203812",
            "telephone_number": "337-991-9276",
            "fax_number": "337-943-0846"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 N Humphreys Blvd",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381202146",
            "country_code": "US",
            "telephone_number": "901-683-0055",
            "fax_number": "901-685-9718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARCUM",
        "first_name": "CAROLYN",
        "middle_name": "RUTH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-13",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "13353",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "A810297",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN13353",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "141621",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00927745",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TN BCBS",
            "identifier": "4182890",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3341699",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168400758",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BCBS",
            "identifier": "1801067251",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.