Active NPI
Angela Marie Cissom, AUD
- Audiologist
- Memphis, TN
National Provider Identifier
1891045282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 01274
- Practice address
- 4646 Poplar Ave
Suite 100
Memphis, TN 38117-4426 - Phone
- (901) 762-0125
- Fax
- (901) 818-3001
- NPI assigned
- Sep 13, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Audiologist | 231H00000X | 01274 | MD | Primary |
Addresses
Primary practice location
4646 Poplar Ave
Suite 100
Memphis, TN 38117-4426
Mailing address
4646 Poplar Ave
Suite 100
Memphis, TN 38117-4426
Phone (901) 762-0125
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1726 | Other | TN | STATE OF TENNESSEE DEPARTMENT OF HEALTH DIVISION OF HEALTH RELATED BOARDS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Hearing Group | Past | Accepting new patients | |
| Ideal Practice Management Group Mi LLC | Audiologist | Past | Accepting new patients |
| Hearing Health USA-General, LLC | Audiologist | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Audiologist-Hearing Aid Fitter
- Columbia, MD
- NPI 1588935670
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478563200000",
"number": "1891045282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4646 POPLAR AVE",
"address_2": "SUITE 100",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381174426",
"telephone_number": "901-762-0125",
"fax_number": "901-818-3001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4646 POPLAR AVE",
"address_2": "SUITE 100",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381174426",
"telephone_number": "901-762-0125",
"fax_number": "901-818-3001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CISSOM",
"first_name": "ANGELA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "AUD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-13",
"last_updated": "2016-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "MD",
"license": "01274",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF TENNESSEE DEPARTMENT OF HEALTH DIVISION OF HEALTH RELATED BOARDS",
"identifier": "1726",
"state": "TN"
}
],
"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 Nov 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.