Individual provider Active NPI

William D Bryan, MD

  • Family Medicine Physician
  • Jackson, TN
National Provider Identifier
1891780474
Registry record updated Nov 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17998 Issued in TN
Practice address
2863 Highway 45 Byp
Jackson, TN 38305-3618
Phone
(731) 664-1375
Fax
(731) 664-1378
NPI assigned
Sep 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 17998 TN Primary

Addresses

Primary practice location

2863 Highway 45 Byp
Jackson, TN 38305-3618

Mailing address

PO Box 400
Jackson, TN 38302-0400
Phone (731) 423-8697

Other identifiers 1

IdentifierTypeStateIssuer
3043068MedicaidTN

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080722000308 TN Practitioner - Family Practice 3870666092 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Tennessee, HSC, College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jackson Clinic PAGroup PAC ID 2668376872, 171 clinicians

Practice addresses (Care Compare)

2859 Hwy 45 Byp
Jackson, TN 38305-3618
Phone (731) 664-1375

2863 Hwy 45 Byp
Jackson, TN 38305-3618
Phone (731) 664-1375

619 Skyline Dr
Jackson, TN 38301-3903
Phone (731) 422-0213

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17998TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Madison County Regional Health Department Past Accepting new patients

Organizations & group practices 2

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": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354147200000",
    "number": "1891780474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383020400",
            "telephone_number": "731-423-8697",
            "fax_number": "731-422-5743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2863 HIGHWAY 45 BYP",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053618",
            "telephone_number": "731-664-1375",
            "fax_number": "731-664-1378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "WILLIAM",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2012-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "17998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3043068",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.