NPIMap

Individual provider Active NPI

Joshua Drew Whitledge, DO

  • Family Medicine Physician
  • South Fulton, TN
National Provider Identifier
1871596767
Registry record updated Sep 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02720 Issued in TN
Practice address
1135 Broadway St
South Fulton, TN 38257-2835
Phone
(731) 479-2606
Fax
(731) 479-2610
NPI assigned
May 24, 2005
Last updated
Sep 6, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02888 KY
Family Medicine Physician 207Q00000X 02720 TN Primary

Addresses

Primary practice location

1135 Broadway St
South Fulton, TN 38257-2835

Mailing address

1135 Broadway St
South Fulton, TN 38257-2835
Phone (731) 479-2606

Other identifiers 3

IdentifierTypeStateIssuer
64111669MedicaidKY
103I089052OtherTNMEDICARE B-TN
4047266MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150708000957 TN Practitioner - Family Practice 6204879802 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Pikeville, Kentucky College of Osteopathic Med, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Martin HealthGroup PAC ID 5193070613, 9 clinicians

Practice addresses (Care Compare)

1135 Broadway St
South Fulton, TN 38257-2835
Phone (731) 479-2606

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2720TNMDClinical Neuropsychologist
02888KYMDFamily Medicine Physician
02720TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Martin Health CurrentSince Jun 1, 2018 Accepting new patients
Martin Health Family Medicine CurrentSince Jun 1, 2018 Accepting new patients
Martin Health Past Accepting new patients

Locations

1135 Broadway St
South Fulton, TN 38257
Phone (731) 479-2606

1135 Broadway St
Ste A
South Fulton, TN 38257
Phone (731) 479-2606

Interoperability endpoints

  • Direct secure messaging: jwhitledge18732@directepic.wth.org

Organizations & group practices 3

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 7

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": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473120000000",
    "number": "1871596767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 BROADWAY ST",
            "city": "SOUTH FULTON",
            "state": "TN",
            "postal_code": "382572835",
            "telephone_number": "731-479-2606",
            "fax_number": "731-479-2610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 BROADWAY ST",
            "city": "SOUTH FULTON",
            "state": "TN",
            "postal_code": "382572835",
            "telephone_number": "731-479-2606",
            "fax_number": "731-479-2610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITLEDGE",
        "first_name": "JOSHUA",
        "middle_name": "DREW",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2016-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "02888",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "02720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64111669",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE B-TN",
            "identifier": "103I089052",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4047266",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Fulton, TN

Sources for this page

Verify at the official NPI Registry.