NPIMap

Organization Active NPI

Baptist Minor Medical Centers Inc

Doing business as Baptist Minor Medical Center

  • Internal Medicine Physician
  • Memphis, TN
National Provider Identifier
1881640118
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
BAPTIST MINOR MEDICAL CENTERS INC
Doing business as
Baptist Minor Medical Center
Practice address
3295 Poplar Ave Ste 105
Memphis, TN 38111-4690
Phone
(901) 327-8188
Fax
(901) 327-8284
NPI assigned
May 26, 2006
Last updated
Sep 30, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
BAPTIST MEMORIAL HEALTH CARE CORP.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Authorized official

Name
Gregory M Duckett
Title
Sr VP/ Clo
Phone
(901) 227-5233

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Family Nurse Practitioner 363LF0000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

3295 Poplar Ave Ste 105
Memphis, TN 38111-4690

Mailing address

350 N Humphreys Blvd
Memphis, TN 38120-2177

Other practice location 1

670 N Germantown Pkwy Ste 18
Cordova, TN 38018-6287
Phone (901) 753-7686

Other practice location 2

7424 US Highway 64 Ste 111
Bartlett, TN 38133-8937
Phone (901) 372-3573

Other practice location 3

8990 Germantown Rd
Olive Branch, MS 38654-8532
Phone (662) 893-1160

Other identifiers 3

IdentifierTypeStateIssuer
3031283OtherTNBLUE CROSS BLUE SHIELD TN
3704220MedicaidTN
09015693MedicaidMS

Other names 1

  • Baptist Minor Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040115000998 TN Part B Supplier - Clinic/Group Practice 9032010715 Receives reassigned benefits from 18 practitioners
Practice locations: Bartlett, TN; Cordova, TN; Memphis, TN
O20040930000707 MS Part B Supplier - Clinic/Group Practice 9032010715 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: Olive Branch, MS

National Provider Directory

National Provider Directory
Part of
Baptist Memorial Health Care Corp

Locations

8990 Germantown Rd
Olive Branch, MS 38654
Phone (662) 893-1160

7424 US Highway 64
Ste 111
Bartlett, TN 38133
Phone (901) 372-3573

3295 Poplar Ave
Ste 105
Memphis, TN 38111
Phone (901) 327-8188

Practitioners & affiliated clinicians

Practitioners 34

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.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1881640118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N HUMPHREYS BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3295 POPLAR AVE STE 105",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381114690",
            "telephone_number": "901-327-8188",
            "fax_number": "901-327-8284"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "670 N Germantown Pkwy Ste 18",
            "address_purpose": "LOCATION",
            "city": "Cordova",
            "state": "TN",
            "postal_code": "380186287",
            "country_code": "US",
            "telephone_number": "901-753-7686",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7424 US Highway 64 Ste 111",
            "address_purpose": "LOCATION",
            "city": "Bartlett",
            "state": "TN",
            "postal_code": "381338937",
            "country_code": "US",
            "telephone_number": "901-372-3573",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8990 Germantown Rd",
            "address_purpose": "LOCATION",
            "city": "Olive Branch",
            "state": "MS",
            "postal_code": "386548532",
            "country_code": "US",
            "telephone_number": "662-893-1160",
            "fax_number": "662-893-1166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BAPTIST MINOR MEDICAL CENTERS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST MEMORIAL HEALTH CARE CORP.",
        "enumeration_date": "2006-05-26",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "DUCKETT",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR VP/ CLO",
        "authorized_official_telephone_number": "901-227-5233"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD TN",
            "identifier": "3031283",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3704220",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015693",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baptist Minor Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.