Organization Active NPI

Tri-State Gastroenterology, P.C.

  • Gastroenterology Physician
  • Memphis, TN
National Provider Identifier
1972540953
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
TRI-STATE GASTROENTEROLOGY, P.C.
Practice address
1264 Wesley Dr
Suite 303
Memphis, TN 38116-6400
Phone
(901) 398-9574
Fax
(901) 398-9581
NPI assigned
May 31, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Gwendolyn Washington Jones
Title
Practice Manager
Phone
(901) 398-9574

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

1264 Wesley Dr
Suite 303
Memphis, TN 38116-6400

Mailing address

1264 Wesley Dr
Suite 303
Memphis, TN 38116-6400
Phone (901) 398-9574

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100415000057 TN Part B Supplier - Clinic/Group Practice 5496656431 Receives reassigned benefits from 1 practitioner
Practice locations: Memphis, TN
O20111018000271 MS Part B Supplier - Clinic/Group Practice 5496656431 Receives reassigned benefits from 1 practitioner
Practice locations: Southaven, MS

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1264 Wesley Dr
Ste 303
Memphis, TN 38116
Phone (901) 398-9574

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72938

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972540953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1264 WESLEY DR",
            "address_2": "SUITE 303",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381166400",
            "telephone_number": "901-398-9574",
            "fax_number": "901-398-9581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1264 WESLEY DR",
            "address_2": "SUITE 303",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381166400",
            "telephone_number": "901-398-9574",
            "fax_number": "901-398-9581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE GASTROENTEROLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_middle_name": "WASHINGTON",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "901-398-9574",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Aug 22, 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.