Active NPI
John R Wickman, M.D., MPH
- Specialist
- Memphis, TN
National Provider Identifier
1871513739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MD0000022064
- Practice address
- 8485 US Highway 64
101
Memphis, TN 38133-4102 - Phone
- (901) 377-3001
- Fax
- (901) 377-3130
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MD0000022064 | TN | Primary |
Addresses
Primary practice location
8485 US Highway 64
101
Memphis, TN 38133-4102
Mailing address
8485 US Highway 64
101
Memphis, TN 38133-4102
Phone (901) 377-3001
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Tennessee, HSC, College of Medicine, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
8485 US Hwy 64
Suite 101
Bartlett, TN 38133-4102
Phone (901) 377-3001
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD0000022064 | TN | MD | Specialist |
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.
-
- Primary Care Clinic/Center
- Memphis, TN
- NPI 1972804110
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1871513739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8485 US HIGHWAY 64",
"address_2": "101",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381334102",
"telephone_number": "901-377-3001",
"fax_number": "901-377-3130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8485 US HIGHWAY 64",
"address_2": "101",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381334102",
"telephone_number": "901-377-3001",
"fax_number": "901-377-3130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKMAN",
"first_name": "JOHN",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "M.D., MPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "TN",
"license": "MD0000022064",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.