NPIMap

Organization Active NPI

Gastrointestinal Specialists Foundation, Inc

  • Gastroenterology Physician
  • Memphis, TN
National Provider Identifier
1942546452
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
GASTROINTESTINAL SPECIALISTS FOUNDATION, INC
Practice address
80 Humphreys Center Dr Ste 200
Memphis, TN 38120-2352
Phone
(901) 578-2538
Fax
(901) 578-2572
NPI assigned
Jan 2, 2013
Last updated
Dec 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2019

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X TN
Certified Registered Nurse Anesthetist 367500000X TN
Gastroenterology Physician 207RG0100X AR
Gastroenterology Physician 207RG0100X TN Primary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X TN

Addresses

Primary practice location

80 Humphreys Center Dr Ste 200
Memphis, TN 38120-2352

Mailing address

PO Box 405827
Atlanta, GA 30384-5800
Phone (901) 578-2538

Other identifiers 2

IdentifierTypeStateIssuer
201063002MedicaidAR
201055002MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, AR, MS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20130315000332 TN Part B Supplier - Clinic/Group Practice 9830334010 Receives reassigned benefits from 20 practitioners
Practice locations: Memphis, TN; Covington, TN; Arlington, TN; Collierville, TN; Brighton, TN
O20130318000453 AR Part B Supplier - Clinic/Group Practice 9830334010 Receives reassigned benefits from 2 practitioners
Practice locations: Marion, AR; West Memphis, AR
O20210111000179 MS Part B Supplier - Clinic/Group Practice 9830334010 Receives reassigned benefits from 7 practitioners
Practice locations: Southaven, MS

National Provider Directory

National Provider Directory

Locations

363 Southcrest Cir
Ste 302
Southaven, MS 38671
Phone (662) 772-4035

5150 Airline Rd
Ste 300
Arlington, TN 38002

7777 Church St
Millington, TN 38053
Phone (901) 872-2020

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1357084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576454400000",
    "number": "1942546452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 405827",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303845800",
            "telephone_number": "901-578-2538",
            "fax_number": "901-578-2572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 HUMPHREYS CENTER DR STE 200",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202352",
            "telephone_number": "901-578-2538",
            "fax_number": "901-578-2572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROINTESTINAL SPECIALISTS FOUNDATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-02",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "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": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AR",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TN",
            "license": null,
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201063002",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201055002",
            "state": "AR"
        }
    ],
    "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 Dec 16, 2019; 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.