{ "result_count": 128, "results": [ { "addresses": [ { "address_1": "331 W MAIN ST STE 503", "address_purpose": "LOCATION", "address_type": "DOM", "city": "DURHAM", "country_code": "US", "country_name": "United States", "postal_code": "277013244", "state": "NC", "telephone_number": "919-619-1802" }, { "address_1": "331 W MAIN ST STE 503", "address_purpose": "MAILING", "address_type": "DOM", "city": "DURHAM", "country_code": "US", "country_name": "United States", "postal_code": "277013244", "state": "NC", "telephone_number": "919-619-1802" } ], "basic": { "authorized_official_credential": "MD", "authorized_official_first_name": "DAVID", "authorized_official_last_name": "THOMAS", "authorized_official_middle_name": "B", "authorized_official_name_prefix": "Dr.", "authorized_official_telephone_number": "9196191802", "authorized_official_title_or_position": "Physician and Managing Member", "certification_date": "2020-01-16", "enumeration_date": "2019-11-20", "last_updated": "2020-01-16", "organization_name": "ACME PATHOLOGY AND LABORATORY, PLLC", "organizational_subpart": "NO", "status": "A" }, "created_epoch": "1574261173000", "endpoints": [], "enumeration_type": "NPI-2", "identifiers": [], "last_updated_epoch": "1579181156000", "number": "1417593971", "other_names": [], "practiceLocations": [ { "address_1": "3495 HACKS CROSS RD STE 201", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "866-939-1825" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": null, "primary": true, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" } ] }, { "addresses": [ { "address_1": "5301 VIRGINIA WAY STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "BRENTWOOD", "country_code": "US", "country_name": "United States", "postal_code": "370277542", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "930 MADISON AVE STE 890", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-302-2834", "postal_code": "381033413", "state": "TN", "telephone_number": "901-866-8834" } ], "basic": { "certification_date": "2025-12-30", "credential": "MD", "enumeration_date": "2018-04-06", "first_name": "AYODELE", "last_name": "ADELANWA", "last_updated": "2025-12-30", "middle_name": "O", "name_prefix": "Dr.", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1523036497000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1767099573000", "number": "1801393921", "other_names": [ { "code": "1", "first_name": "AYODELE", "last_name": "AKINYEMI", "middle_name": "O", "type": "Former Name" } ], "practiceLocations": [ { "address_1": "1901 PHOENIX BLVD STE 210", "address_purpose": "LOCATION", "address_type": "DOM", "city": "ATLANTA", "country_code": "US", "country_name": "United States", "postal_code": "303495062", "state": "GA", "telephone_number": "800-994-1030" } ], "taxonomies": [ { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "71151", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "95992", "primary": false, "state": "GA", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "71151", "primary": false, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "5959 PARK AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-765-2064", "postal_code": "38119", "state": "TN", "telephone_number": "901-765-2731" }, { "address_1": "PO BOX 1483", "address_purpose": "MAILING", "address_type": "DOM", "city": "INDIANAPOLIS", "country_code": "US", "country_name": "United States", "fax_number": "317-663-6054", "postal_code": "462061483", "state": "IN", "telephone_number": "317-663-6055" } ], "basic": { "credential": "MD", "enumeration_date": "2006-02-28", "first_name": "JUSTIN", "last_name": "ADLER", "last_updated": "2017-01-31", "middle_name": "C", "name_prefix": "--", "name_suffix": "Jr.", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1141155940000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "06737859", "issuer": null, "state": "MS" }, { "code": "05", "desc": "MEDICAID", "identifier": "102015001", "issuer": null, "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "3141500", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1485889590000", "number": "1427024397", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "9947", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2020-06-02", "credential": "M.B.B.S., MD", "enumeration_date": "2008-06-12", "first_name": "MAHA", "last_name": "AL-KHAWAJA", "last_updated": "2020-06-02", "sex": "F", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1213311615000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1591121068000", "number": "1891955845", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": "11013316A", "primary": false, "state": "IN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MD45807", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "14275 MIDWAY RD STE 400", "address_purpose": "MAILING", "address_type": "DOM", "city": "ADDISON", "country_code": "US", "country_name": "United States", "fax_number": "610-271-4245", "postal_code": "750013661", "state": "TX", "telephone_number": "214-932-8018" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381258803", "state": "TN", "telephone_number": "888-244-7284" } ], "basic": { "authorized_official_credential": "MD", "authorized_official_first_name": "ROBERT", "authorized_official_last_name": "QUIREY", "authorized_official_telephone_number": "8008906220", "authorized_official_title_or_position": "AO", "certification_date": "2024-06-10", "enumeration_date": "2024-06-11", "last_updated": "2024-06-11", "organization_name": "AMERIPATH INDIANAPOLIS PC", "organizational_subpart": "YES", "parent_organization_legal_business_name": "AMERIPATH INC", "status": "A" }, "created_epoch": "1718109602000", "endpoints": [], "enumeration_type": "NPI-2", "identifiers": [], "last_updated_epoch": "1718109602000", "number": "1013759059", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": null, "primary": true, "state": null, "taxonomy_group": "193400000X - Single Specialty Group" } ] }, { "addresses": [ { "address_1": "PO BOX 603283", "address_purpose": "MAILING", "address_type": "DOM", "city": "CHARLOTTE", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "282603283", "state": "NC", "telephone_number": "901-516-7182" }, { "address_1": "1265 UNION AVE", "address_2": "DEPT OF PATHOLOGY, 6 SHERARD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "381043415", "state": "TN", "telephone_number": "901-516-7182" } ], "basic": { "credential": "M.D.", "enumeration_date": "2006-04-19", "first_name": "MAHUL", "last_name": "AMIN", "last_updated": "2016-12-15", "middle_name": "B", "name_prefix": "--", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1145476909000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1481813194000", "number": "1073578399", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "174400000X", "desc": "Specialist", "license": "C52183", "primary": false, "state": "CA", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "55160", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-271-2606", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-271-2606", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2026-01-28", "credential": "M.D.", "enumeration_date": "2006-05-11", "first_name": "AMY", "last_name": "ARIAS", "last_updated": "2026-01-28", "middle_name": "JO", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1147397024000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1769629631000", "number": "1154371854", "other_names": [ { "code": "2", "credential": "MD", "first_name": "AMY", "last_name": "ARIAS", "prefix": "Dr.", "type": "Professional Name" } ], "practiceLocations": [ { "address_1": "1800 E LAKE SHORE DR", "address_purpose": "LOCATION", "address_type": "DOM", "city": "DECATUR", "country_code": "US", "country_name": "United States", "fax_number": "217-464-3193", "postal_code": "625213810", "state": "IL", "telephone_number": "217-464-2966" }, { "address_1": "1800 E LAKE SHORE DR", "address_purpose": "LOCATION", "address_type": "DOM", "city": "DECATUR", "country_code": "US", "country_name": "United States", "fax_number": "217-464-3193", "postal_code": "625213810", "state": "IL", "telephone_number": "217-464-2966" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "47819", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "036115646", "primary": false, "state": "IL", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN", "telephone_number": "901-595-3300" }, { "address_1": "262 DANNY THOMAS PL # MS 515", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN" } ], "basic": { "certification_date": "2025-02-12", "credential": "M.D.", "enumeration_date": "2016-04-21", "first_name": "KAREN", "last_name": "ARISPE ANGULO", "last_updated": "2025-02-12", "middle_name": "ROCIO", "sex": "F", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1461291975000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1739369473000", "number": "1841644267", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0007X", "desc": "Pathology, Molecular Genetic Pathology", "license": "72915", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": "69020-20", "primary": false, "state": "WI", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "72915", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "680 CENTRE ST", "address_purpose": "MAILING", "address_type": "DOM", "city": "BROCKTON", "country_code": "US", "country_name": "United States", "postal_code": "023023308", "state": "MA", "telephone_number": "508-941-7000" }, { "address_1": "877 JEFFERSON AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381032807", "state": "TN", "telephone_number": "901-545-6969" } ], "basic": { "certification_date": "2026-04-30", "credential": "MD", "enumeration_date": "2007-04-19", "first_name": "ABDALLAH", "last_name": "AZOUZ", "last_updated": "2026-04-30", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1177024059000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1777557846000", "number": "1336366293", "other_names": [], "practiceLocations": [ { "address_1": "800 ROSE ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "LEXINGTON", "country_code": "US", "country_name": "United States", "postal_code": "405360293", "state": "KY", "telephone_number": "859-257-1446" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "46848", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "285679", "primary": false, "state": "MA", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "C5282", "primary": false, "state": "KY", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-595-3842", "postal_code": "381053678", "state": "TN", "telephone_number": "901-595-3300" }, { "address_1": "1475 LEFLEUR PL", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381203103", "state": "TN" } ], "basic": { "certification_date": "2024-09-05", "credential": "MD", "enumeration_date": "2008-06-24", "first_name": "ARMITA", "last_name": "BAHRAMI", "last_updated": "2024-09-05", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1214331763000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1725558341000", "number": "1013178854", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0105X", "desc": "Pathology, Clinical Pathology/Laboratory Medicine", "license": "103732", "primary": false, "state": "MN", "taxonomy_group": "" }, { "code": "207ZP0105X", "desc": "Pathology, Clinical Pathology/Laboratory Medicine", "license": "51045", "primary": false, "state": "MN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "85323", "primary": true, "state": "GA", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "PO BOX 1483", "address_purpose": "MAILING", "address_type": "DOM", "city": "INDIANAPOLIS", "country_code": "US", "country_name": "United States", "fax_number": "317-705-5060", "postal_code": "462061483", "state": "IN", "telephone_number": "877-262-6446" }, { "address_1": "5959 PARK AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-765-2064", "postal_code": "381195200", "state": "TN", "telephone_number": "901-765-2131" } ], "basic": { "credential": "M.D.", "enumeration_date": "2005-12-12", "first_name": "LOUISA", "last_name": "BALAZS", "last_updated": "2017-01-31", "name_prefix": "--", "name_suffix": "--", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1134426674000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3820016", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1485893603000", "number": "1306821400", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "027777", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "5301 VIRGINIA WAY STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "BRENTWOOD", "country_code": "US", "country_name": "United States", "postal_code": "370277542", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "6019 WALNUT GROVE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381202113", "state": "TN", "telephone_number": "901-227-5135" } ], "basic": { "certification_date": "2024-12-13", "credential": "MD", "enumeration_date": "2009-04-01", "first_name": "CHARLES", "last_name": "BEAVERS", "last_updated": "2024-12-13", "middle_name": "T.", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1238595171000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "01", "desc": "Other (non-Medicare)", "identifier": "04-45362", "issuer": "license", "state": "KS" } ], "last_updated_epoch": "1734102919000", "number": "1235371691", "other_names": [], "practiceLocations": [ { "address_1": "1235 E CHEROKEE ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "SPRINGFIELD", "country_code": "US", "country_name": "United States", "postal_code": "65804", "state": "MO", "telephone_number": "417-820-2961" }, { "address_1": "11070 STRANG LINE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "LENEXA", "country_code": "US", "country_name": "United States", "postal_code": "662152113", "state": "KS", "telephone_number": "816-241-3338" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "2014007653", "primary": false, "state": "MO", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "04-45362", "primary": false, "state": "KS", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "73079", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1010 AIRPARK CENTER DR", "address_purpose": "MAILING", "address_type": "DOM", "city": "NASHVILLE", "country_code": "US", "country_name": "United States", "postal_code": "372175200", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "1010 AIRPARK CENTER DR", "address_purpose": "LOCATION", "address_type": "DOM", "city": "NASHVILLE", "country_code": "US", "country_name": "United States", "postal_code": "372175200", "state": "TN", "telephone_number": "615-562-9200" } ], "basic": { "certification_date": "2023-07-18", "credential": "MD", "enumeration_date": "2006-06-01", "first_name": "GAIL", "last_name": "BENTLEY", "last_updated": "2023-07-18", "sex": "F", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1149213002000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1689706048000", "number": "1801833322", "other_names": [], "practiceLocations": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "taxonomies": [ { "code": "207ZH0000X", "desc": "Pathology, Hematology", "license": "49988", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "49988", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "PO BOX 1483", "address_purpose": "MAILING", "address_type": "DOM", "city": "INDIANAPOLIS", "country_code": "US", "country_name": "United States", "postal_code": "462061483", "state": "IN", "telephone_number": "877-262-6446" }, { "address_1": "5959 PARK AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-765-2064", "postal_code": "38119", "state": "TN", "telephone_number": "901-765-2131" } ], "basic": { "credential": "MD", "enumeration_date": "2006-02-28", "first_name": "ALLEN", "last_name": "BERRY", "last_updated": "2017-01-31", "middle_name": "D", "name_prefix": "--", "name_suffix": "III", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1141162449000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "117237001", "issuer": null, "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "3046982", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1485889841000", "number": "1750358685", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "15224", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1265 UNION AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38104", "state": "TN", "telephone_number": "901-516-7182" }, { "address_1": "PO BOX 603283", "address_purpose": "MAILING", "address_type": "DOM", "city": "CHARLOTTE", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "282603283", "state": "NC", "telephone_number": "901-516-7182" } ], "basic": { "credential": "MD", "enumeration_date": "2012-07-23", "first_name": "AVA", "last_name": "BHATTARAI", "last_updated": "2018-08-24", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1343091331000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "Q037673", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1535127360000", "number": "1164777462", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "57606", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "PO BOX 23329", "address_purpose": "MAILING", "address_type": "DOM", "city": "NEW YORK", "country_code": "US", "country_name": "United States", "postal_code": "100873329", "state": "NY" }, { "address_1": "2006 NEW GARDEN RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "GREENSBORO", "country_code": "US", "country_name": "United States", "postal_code": "274102566", "state": "NC", "telephone_number": "336-609-6240" } ], "basic": { "certification_date": "2026-05-07", "credential": "M.D.", "enumeration_date": "2009-02-14", "first_name": "RADOSLAW", "last_name": "BIENIEK", "last_updated": "2026-05-07", "middle_name": "FILIP", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1234632239000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1778145538000", "number": "1083853006", "other_names": [], "practiceLocations": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "taxonomies": [ { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "44583", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MD44583", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "221105", "primary": false, "state": "MA", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" }, { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" } ], "basic": { "credential": "MD", "enumeration_date": "2005-12-02", "first_name": "ALAN", "last_name": "BOOM", "last_updated": "2007-12-27", "middle_name": "D", "name_prefix": "--", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1133538639000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3053894", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1198776084000", "number": "1265416333", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "019703", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1265 UNION AVE", "address_2": "DEPT OF PATHOLOGY, 6 SHERARD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38104", "state": "TN", "telephone_number": "901-516-7182" }, { "address_1": "1211 UNION AVE STE 330", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381046655", "state": "TN" } ], "basic": { "certification_date": "2025-05-01", "credential": "M.D.", "enumeration_date": "2005-12-06", "first_name": "ROBERT", "last_name": "BRADLEY", "last_updated": "2025-05-13", "middle_name": "M", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1133896823000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3093072", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1747144688000", "number": "1124002704", "other_names": [], "practiceLocations": [ { "address_1": "4250 BETHEL RD DEPT OF", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OLIVE BRANCH", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "386548737", "state": "MS", "telephone_number": "901-516-7182" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "15294", "primary": false, "state": "MS", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "015294", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "5301 VIRGINIA WAY STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "BRENTWOOD", "country_code": "US", "country_name": "United States", "postal_code": "370277542", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "1000 BLYTHE BLVD", "address_2": "4TH FLOOR, PATHOLOGY", "address_purpose": "LOCATION", "address_type": "DOM", "city": "CHARLOTTE", "country_code": "US", "country_name": "United States", "postal_code": "282035812", "state": "NC", "telephone_number": "704-379-5979" } ], "basic": { "certification_date": "2025-10-03", "credential": "M.D", "enumeration_date": "2005-08-09", "first_name": "BENJAMIN", "last_name": "CALHOUN", "last_updated": "2025-10-03", "middle_name": "CARLISLE", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1123612420000", "endpoints": [ { "address_1": "101 Manning Dr Fl 3", "address_type": "DOM", "affiliation": "N", "city": "Chapel Hill", "contentOtherDescription": "CDA/CCD/TXT", "contentType": "OTHER", "contentTypeDescription": "Other", "country_code": "US", "country_name": "United States", "endpoint": "bcalhoun306789@direct.UNC.nchie.net", "endpointType": "DIRECT", "endpointTypeDescription": "Direct Messaging Address", "postal_code": "275144220", "state": "NC", "use": "DIRECT", "useDescription": "Direct" } ], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "8913707", "issuer": null, "state": "NC" } ], "last_updated_epoch": "1759518003000", "number": "1578564076", "other_names": [], "practiceLocations": [ { "address_1": "6019 WALNUT GROVE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381202113", "state": "TN", "telephone_number": "901-226-5000" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "37146", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "200400827", "primary": true, "state": "NC", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "5301 VIRGINIA WAY STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "BRENTWOOD", "country_code": "US", "country_name": "United States", "postal_code": "370277542", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "6019 WALNUT GROVE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381202113", "state": "TN", "telephone_number": "901-227-5135" } ], "basic": { "certification_date": "2025-04-08", "enumeration_date": "2015-07-02", "first_name": "KATELYNN", "last_name": "CAMPBELL", "last_updated": "2025-04-08", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1435852917000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1744121637000", "number": "1194108589", "other_names": [], "practiceLocations": [ { "address_1": "4301 WEST MARKHAM, SLOT 517", "address_purpose": "LOCATION", "address_type": "DOM", "city": "LITTLE ROCK", "country_code": "US", "country_name": "United States", "postal_code": "722057199", "state": "AR", "telephone_number": "501-686-5356" }, { "address_1": "4301 W MARKHAM ST # 783", "address_purpose": "LOCATION", "address_type": "DOM", "city": "LITTLE ROCK", "country_code": "US", "country_name": "United States", "postal_code": "722057101", "state": "AR", "telephone_number": "016-868-8000" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "E-119956", "primary": false, "state": "AR", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "72438", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1010 AIRPARK CENTER DR", "address_purpose": "MAILING", "address_type": "DOM", "city": "NASHVILLE", "country_code": "US", "country_name": "United States", "postal_code": "372175200", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "6019 WALNUT GROVE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381202113", "state": "TN", "telephone_number": "901-227-5135" } ], "basic": { "certification_date": "2023-07-03", "credential": "M.D.", "enumeration_date": "2014-06-19", "first_name": "DIANA", "last_name": "CASTRO VILLABON", "last_updated": "2023-07-03", "middle_name": "PATRICIA", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1403225998000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1688388952000", "number": "1063826717", "other_names": [], "practiceLocations": [ { "address_1": "655 W 8TH ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "JACKSONVILLE", "country_code": "US", "country_name": "United States", "fax_number": "904-244-4060", "postal_code": "32209", "state": "FL", "telephone_number": "904-244-4889" } ], "taxonomies": [ { "code": "207ZC0500X", "desc": "Pathology, Cytopathology", "license": "ME151176", "primary": false, "state": "FL", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "ME151176", "primary": false, "state": "FL", "taxonomy_group": "" }, { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "68246", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "6019 WALNUT GROVE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381202113", "state": "TN", "telephone_number": "901-227-5135" }, { "address_1": "5301 VIRGINIA WAY STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "BRENTWOOD", "country_code": "US", "country_name": "United States", "postal_code": "370277542", "state": "TN", "telephone_number": "615-221-4400" } ], "basic": { "certification_date": "2025-08-26", "credential": "MD", "enumeration_date": "2018-05-01", "first_name": "GREGORY", "last_name": "CHAMBERLIN", "last_updated": "2025-08-26", "middle_name": "MARK", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1525229979000", "endpoints": [ { "address_1": "101 Manning Dr", "address_type": "DOM", "affiliation": "N", "city": "Chapel Hill", "contentOtherDescription": "CDA/CCD/TXT", "contentType": "OTHER", "contentTypeDescription": "Other", "country_code": "US", "country_name": "United States", "endpoint": "gchamberlin439088@direct.UNC.nchie.net", "endpointType": "DIRECT", "endpointTypeDescription": "Direct Messaging Address", "postal_code": "275144220", "state": "NC", "use": "DIRECT", "useDescription": "Direct" } ], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1756219172000", "number": "1861981250", "other_names": [], "practiceLocations": [ { "address_1": "101 MANNING DR", "address_purpose": "LOCATION", "address_type": "DOM", "city": "CHAPEL HILL", "country_code": "US", "country_name": "United States", "postal_code": "275144220", "state": "NC", "telephone_number": "984-974-9137" }, { "address_1": "7601 SOUTHCREST PKWY", "address_purpose": "LOCATION", "address_type": "DOM", "city": "SOUTHAVEN", "country_code": "US", "country_name": "United States", "postal_code": "386714739", "state": "MS", "telephone_number": "901-227-5135" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "35763", "primary": true, "state": "MS", "taxonomy_group": "" }, { "code": "207ZP0101X", "desc": "Pathology, Anatomic Pathology", "license": "2022-01454", "primary": false, "state": "NC", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE STE 330", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-478-0951", "postal_code": "381046655", "state": "TN", "telephone_number": "901-478-0954" }, { "address_1": "4250 BETHEL RD DEPT OF", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OLIVE BRANCH", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "386548737", "state": "MS", "telephone_number": "901-516-7084" } ], "basic": { "certification_date": "2022-10-21", "credential": "M.D.", "enumeration_date": "2006-09-07", "first_name": "LISA", "last_name": "CHANDLER", "last_updated": "2022-10-21", "name_prefix": "Dr.", "sex": "F", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1157657236000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "00123848", "issuer": null, "state": "MS" } ], "last_updated_epoch": "1666371088000", "number": "1780787143", "other_names": [], "practiceLocations": [ { "address_1": "1207 OFFICE PARK DR.", "address_2": "SUITE A", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OXFORD", "country_code": "US", "country_name": "United States", "fax_number": "662-513-5747", "postal_code": "38655", "state": "MS", "telephone_number": "662-513-5753" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "11707", "primary": true, "state": "MS", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-271-2618", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2024-08-26", "credential": "MD", "enumeration_date": "2006-08-11", "first_name": "CHANGHYUN", "last_name": "CHOI", "last_updated": "2024-08-26", "middle_name": "MICHAEL", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1155272914000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "01", "desc": "Other (non-Medicare)", "identifier": "000000135404", "issuer": "ANTHEM BC/BS", "state": "OH" }, { "code": "05", "desc": "MEDICAID", "identifier": "0893510", "issuer": null, "state": "OH" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "341632753", "issuer": "AULTCARE", "state": "OH" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "341632753002", "issuer": "MEDICAL MUTUAL", "state": "OH" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "341632753029", "issuer": "CARESOURCE", "state": "OH" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "341632753P", "issuer": "SUMMACARE", "state": "OH" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "89601", "issuer": "QUALCHOICE", "state": "OH" } ], "last_updated_epoch": "1724700764000", "number": "1114938578", "other_names": [ { "code": "5", "credential": "MD", "first_name": "C", "last_name": "CHOI", "middle_name": "MICHAEL", "type": "Other Name" } ], "practiceLocations": [ { "address_1": "100 CHARLES LINDBERGH BLVD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "UNIONDALE", "country_code": "US", "country_name": "United States", "fax_number": "516-512-5301", "postal_code": "115533631", "state": "NY", "telephone_number": "516-512-5200" }, { "address_1": "100 CHARLES LINDBERGH BLVD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "UNIONDALE", "country_code": "US", "country_name": "United States", "fax_number": "516-512-5301", "postal_code": "115533631", "state": "NY", "telephone_number": "516-512-5200" } ], "taxonomies": [ { "code": "207ZC0500X", "desc": "Pathology, Cytopathology", "license": "41778", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "35-050962C", "primary": false, "state": "OH", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "41778", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1265 UNION AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "381043415", "state": "TN", "telephone_number": "901-516-7182" }, { "address_1": "1265 UNION AVE", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "381043415", "state": "TN", "telephone_number": "901-516-7182" } ], "basic": { "credential": "MD", "enumeration_date": "2017-11-09", "first_name": "IAN", "last_name": "CLARK", "last_updated": "2018-10-08", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1510242966000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "Q033048", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1539008867000", "number": "1669985958", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "56522", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2026-02-27", "credential": "MD, PhD", "enumeration_date": "2012-06-12", "first_name": "LANI", "last_name": "CLINTON", "last_updated": "2026-02-27", "middle_name": "KAI", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1339476537000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "200025600", "issuer": null, "state": "MS" }, { "code": "05", "desc": "MEDICAID", "identifier": "Q090025", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1772200193000", "number": "1396007878", "other_names": [], "practiceLocations": [ { "address_1": "651 ILALO ST", "address_2": "MEB #401A", "address_purpose": "LOCATION", "address_type": "DOM", "city": "HONOLULU", "country_code": "US", "country_name": "United States", "postal_code": "968135525", "state": "HI", "telephone_number": "808-692-1131" }, { "address_1": "51 GERMANTOWN CT STE 309", "address_purpose": "LOCATION", "address_type": "DOM", "city": "CORDOVA", "country_code": "US", "country_name": "United States", "fax_number": "901-747-2380", "postal_code": "380184290", "state": "TN", "telephone_number": "901-333-0510" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "69136", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "2017-01610", "primary": false, "state": "NC", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2020-06-05", "credential": "MD", "enumeration_date": "2005-08-03", "first_name": "PATRICK", "last_name": "DEAN", "last_updated": "2020-06-05", "middle_name": "JOSEPH", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1123092002000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "0116337", "issuer": null, "state": "MS" }, { "code": "05", "desc": "MEDICAID", "identifier": "128916002", "issuer": null, "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "3707559", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1591377979000", "number": "1346241064", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MD14742", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "5012 S US HIGHWAY 75", "address_2": "SUITE 160", "address_purpose": "LOCATION", "address_type": "DOM", "city": "DENISON", "country_code": "US", "country_name": "United States", "fax_number": "903-463-4545", "postal_code": "750204587", "state": "TX", "telephone_number": "903-463-1004" }, { "address_1": "5301 VIRGINIA WAY STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "BRENTWOOD", "country_code": "US", "country_name": "United States", "postal_code": "370277542", "state": "TN", "telephone_number": "615-221-4400" } ], "basic": { "certification_date": "2024-07-03", "credential": "M.D.", "enumeration_date": "2007-05-22", "first_name": "ROBIN", "last_name": "DOBSON", "last_updated": "2024-07-03", "middle_name": "W", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1179870286000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "01", "desc": "Other (non-Medicare)", "identifier": "8CQ988", "issuer": "Blue Cross Blue Shield of Texas", "state": "TX" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "N3623", "issuer": "License", "state": "TX" } ], "last_updated_epoch": "1720035925000", "number": "1184833121", "other_names": [], "practiceLocations": [ { "address_1": "6019 WALNUT GROVE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381202113", "state": "TN", "telephone_number": "156-221-4400" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "N3623", "primary": true, "state": "TX", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "5301 VIRGINIA WAY STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "BRENTWOOD", "country_code": "US", "country_name": "United States", "postal_code": "370277542", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "6019 WALNUT GROVE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381202113", "state": "TN", "telephone_number": "901-227-5135" } ], "basic": { "certification_date": "2025-08-18", "credential": "M.D.", "enumeration_date": "2007-04-24", "first_name": "MATTHEW", "last_name": "DRESS", "last_updated": "2025-08-18", "middle_name": "A", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1177451937000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1755535704000", "number": "1538388012", "other_names": [], "practiceLocations": [ { "address_1": "7550 WOLF RIVER BLVD", "address_2": "SUITE 200", "address_purpose": "LOCATION", "address_type": "DOM", "city": "GERMANTOWN", "country_code": "US", "country_name": "United States", "fax_number": "901-542-6871", "postal_code": "381381745", "state": "TN", "telephone_number": "901-542-6801" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "43431", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" }, { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" } ], "basic": { "authorized_official_first_name": "DOROTHY", "authorized_official_last_name": "BLACK", "authorized_official_middle_name": "L", "authorized_official_name_prefix": "--", "authorized_official_name_suffix": "--", "authorized_official_telephone_number": "9017257551", "authorized_official_title_or_position": "Managed care coordinator", "enumeration_date": "2005-12-06", "last_updated": "2007-09-06", "organization_name": "DUCKWORTH PATHOLOGY GROUP, INC.", "organizational_subpart": "NO", "status": "A" }, "created_epoch": "1133905450000", "endpoints": [], "enumeration_type": "NPI-2", "identifiers": [], "last_updated_epoch": "1189087752000", "number": "1154305779", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": null, "primary": true, "state": null, "taxonomy_group": "193400000X - Single Specialty Group" } ] }, { "addresses": [ { "address_1": "262 DANNY THOMAS PL # MS 515", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN" }, { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN", "telephone_number": "901-595-3300" } ], "basic": { "certification_date": "2025-07-15", "credential": "MD", "enumeration_date": "2018-04-16", "first_name": "SHUYU", "last_name": "E", "last_updated": "2025-07-15", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1523894776000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1752579259000", "number": "1033606041", "other_names": [], "practiceLocations": [ { "address_1": "1515 HOLCOMBE BLVD UNIT 72", "address_purpose": "LOCATION", "address_type": "DOM", "city": "HOUSTON", "country_code": "US", "country_name": "United States", "postal_code": "770304000", "state": "TX", "telephone_number": "713-745-4798" } ], "taxonomies": [ { "code": "207ZH0000X", "desc": "Pathology, Hematology", "license": "64682", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "64682", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN", "telephone_number": "888-226-4343" }, { "address_1": "262 DANNY THOMAS PL # MS 515", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN" } ], "basic": { "certification_date": "2021-10-15", "credential": "M.D.", "enumeration_date": "2016-06-24", "first_name": "MOHAMMAD", "last_name": "ELDOMERY", "last_updated": "2021-10-15", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1466805496000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1634319571000", "number": "1588015143", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": "11018989A", "primary": false, "state": "IN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "63826", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0007X", "desc": "Pathology, Molecular Genetic Pathology", "license": "63826", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" }, { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" } ], "basic": { "credential": "MD", "enumeration_date": "2005-12-02", "first_name": "NOEL", "last_name": "FLORENDO", "last_updated": "2007-12-27", "middle_name": "T", "name_prefix": "--", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1133541601000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3040373", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1198775259000", "number": "1164406245", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "009340", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN", "telephone_number": "888-226-4343" }, { "address_1": "262 DANNY THOMAS PL # MS 515", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN" } ], "basic": { "credential": "M.D.", "enumeration_date": "2008-11-20", "first_name": "LARISSA", "last_name": "FURTADO", "last_updated": "2019-10-25", "middle_name": "VIANA", "name_prefix": "Dr.", "sex": "F", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1227203390000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1572011469000", "number": "1881849602", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0007X", "desc": "Pathology, Molecular Genetic Pathology", "license": "036.133808", "primary": false, "state": "IL", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "60114", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0007X", "desc": "Pathology, Molecular Genetic Pathology", "license": "60114", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "ONE GI CREDENTIALING DEPARTMENT", "address_2": "PO BOX 381468", "address_purpose": "MAILING", "address_type": "DOM", "city": "GERMANTOWN", "country_code": "US", "country_name": "United States", "postal_code": "381831468", "state": "TN" }, { "address_1": "8000 WOLF RIVER BLVD STE 200", "address_purpose": "LOCATION", "address_type": "DOM", "city": "GERMANTOWN", "country_code": "US", "country_name": "United States", "postal_code": "381381755", "state": "TN", "telephone_number": "901-747-3630" } ], "basic": { "authorized_official_first_name": "KRISTINA", "authorized_official_last_name": "MATERNA", "authorized_official_telephone_number": "9013778219", "authorized_official_title_or_position": "DIRECTOR, CREDENTIALING", "certification_date": "2026-02-03", "enumeration_date": "2005-12-13", "last_updated": "2026-02-03", "organization_name": "GASTROENTEROLOGY CENTER OF THE MIDSOUTH PLLC", "organizational_subpart": "NO", "status": "A" }, "created_epoch": "1134494806000", "endpoints": [], "enumeration_type": "NPI-2", "identifiers": [], "last_updated_epoch": "1770130431000", "number": "1417932492", "other_names": [ { "code": "3", "organization_name": "GASTROENTEROLOGY ASSOCIATES OF NORTH MISSISSIPPI", "type": "Doing Business As" }, { "code": "3", "organization_name": "DIGESTIVE HEALTH SPECIALISTS", "type": "Doing Business As" }, { "code": "3", "organization_name": "MIDSTATE GASTROENTEROLOGY", "type": "Doing Business As" }, { "code": "3", "organization_name": "ASSOCIATES IN GASTROENTEROLOGY", "type": "Doing Business As" }, { "code": "3", "organization_name": "SKYLINE GASTROENTEROLOGY OF WEST TENNESSEE", "type": "Doing Business As" }, { "code": "3", "organization_name": "GASTRO ONE", "type": "Doing Business As" } ], "practiceLocations": [ { "address_1": "27 MEDICAL CENTER DR", "address_purpose": "LOCATION", "address_type": "DOM", "city": "JACKSON", "country_code": "US", "country_name": "United States", "postal_code": "383013949", "state": "TN", "telephone_number": "731-424-1001" }, { "address_1": "7900 AIRWAYS BLVD BLDG B STE 100", "address_purpose": "LOCATION", "address_type": "DOM", "city": "SOUTHAVEN", "country_code": "US", "country_name": "United States", "postal_code": "386714116", "state": "MS", "telephone_number": "662-349-6950" }, { "address_1": "5653 FRIST BLVD STE 530", "address_purpose": "LOCATION", "address_type": "DOM", "city": "HERMITAGE", "country_code": "US", "country_name": "United States", "postal_code": "370762067", "state": "TN", "telephone_number": "615-885-1093" }, { "address_1": "589 GARFIELD ST STE 201", "address_purpose": "LOCATION", "address_type": "DOM", "city": "TUPELO", "country_code": "US", "country_name": "United States", "postal_code": "388016301", "state": "MS", "telephone_number": "662-680-5565" }, { "address_1": "660 S MOUNT JULIET RD STE 220", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MT JULIET", "country_code": "US", "country_name": "United States", "postal_code": "371223920", "state": "TN", "telephone_number": "615-885-1093" }, { "address_1": "920 S HARTMANN DR STE 310", "address_purpose": "LOCATION", "address_type": "DOM", "city": "LEBANON", "country_code": "US", "country_name": "United States", "postal_code": "370904137", "state": "TN", "telephone_number": "615-885-1093" }, { "address_1": "1208 OFFICE PARK DR", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OXFORD", "country_code": "US", "country_name": "United States", "postal_code": "386553597", "state": "MS", "telephone_number": "662-234-9888" }, { "address_1": "200 STATE HIGHWAY 30 W", "address_purpose": "LOCATION", "address_type": "DOM", "city": "NEW ALBANY", "country_code": "US", "country_name": "United States", "postal_code": "386523112", "state": "MS", "telephone_number": "662-234-9888" }, { "address_1": "825 W MONROE ST STE 2", "address_purpose": "LOCATION", "address_type": "DOM", "city": "GRENADA", "country_code": "US", "country_name": "United States", "postal_code": "389015042", "state": "MS", "telephone_number": "662-234-9888" }, { "address_1": "1210 OFFICE PARK DR", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OXFORD", "country_code": "US", "country_name": "United States", "postal_code": "386553606", "state": "MS", "telephone_number": "662-234-9888" }, { "address_1": "1324 WOLF PARK DR", "address_purpose": "LOCATION", "address_type": "DOM", "city": "GERMANTOWN", "country_code": "US", "country_name": "United States", "fax_number": "901-755-4321", "postal_code": "381381741", "state": "TN", "telephone_number": "901-755-9110" }, { "address_1": "1325 EASTMORELAND AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381043519", "state": "TN", "telephone_number": "901-261-6650" }, { "address_1": "3350 N GERMANTOWN RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "BARTLETT", "country_code": "US", "country_name": "United States", "postal_code": "381334026", "state": "TN", "telephone_number": "901-337-7211" }, { "address_1": "51 GERMANTOWN CT STE 309", "address_purpose": "LOCATION", "address_type": "DOM", "city": "CORDOVA", "country_code": "US", "country_name": "United States", "postal_code": "380184290", "state": "TN", "telephone_number": "901-333-0510" }, { "address_1": "1115B DOW ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MURFREESBORO", "country_code": "US", "country_name": "United States", "postal_code": "371302487", "state": "TN", "telephone_number": "615-896-6996" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "367500000X", "desc": "Nurse Anesthetist, Certified Registered", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "363L00000X", "desc": "Nurse Practitioner", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "207RG0100X", "desc": "Internal Medicine, Gastroenterology", "license": null, "primary": true, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" } ] }, { "addresses": [ { "address_1": "80 HUMPHREYS CENTER DR STE 200", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-578-2572", "postal_code": "381202352", "state": "TN", "telephone_number": "901-578-2538" }, { "address_1": "PO BOX 405827", "address_purpose": "MAILING", "address_type": "DOM", "city": "ATLANTA", "country_code": "US", "country_name": "United States", "fax_number": "901-578-2572", "postal_code": "303845800", "state": "GA", "telephone_number": "901-578-2538" } ], "basic": { "authorized_official_first_name": "GREGORY", "authorized_official_last_name": "DUCKETT", "authorized_official_middle_name": "M", "authorized_official_telephone_number": "9012275233", "authorized_official_title_or_position": "Sr VP/CLO", "certification_date": "2019-12-16", "enumeration_date": "2013-01-02", "last_updated": "2019-12-16", "organization_name": "GASTROINTESTINAL SPECIALISTS FOUNDATION, INC", "organizational_subpart": "NO", "status": "A" }, "created_epoch": "1357169693000", "endpoints": [], "enumeration_type": "NPI-2", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "201055002", "issuer": null, "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "201063002", "issuer": null, "state": "AR" } ], "last_updated_epoch": "1576525093000", "number": "1942546452", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207RG0100X", "desc": "Internal Medicine, Gastroenterology", "license": null, "primary": false, "state": "AR", "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": null, "primary": false, "state": "TN", "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "363LF0000X", "desc": "Nurse Practitioner, Family", "license": null, "primary": false, "state": "TN", "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "367500000X", "desc": "Nurse Anesthetist, Certified Registered", "license": null, "primary": false, "state": "TN", "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "207RG0100X", "desc": "Internal Medicine, Gastroenterology", "license": null, "primary": true, "state": "TN", "taxonomy_group": "193200000X - Multi-Specialty Group" } ] }, { "addresses": [ { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-595-3842", "postal_code": "381053678", "state": "TN", "telephone_number": "901-595-3300" }, { "address_1": "262 DANNY THOMAS PL", "address_2": "MS 515", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-595-3842", "postal_code": "381053678", "state": "TN" } ], "basic": { "certification_date": "2025-05-20", "credential": "MD", "enumeration_date": "2005-05-23", "first_name": "TERRENCE", "last_name": "GEIGER", "last_updated": "2025-05-20", "middle_name": "L", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1116867026000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "00121226", "issuer": null, "state": "MS" }, { "code": "05", "desc": "MEDICAID", "identifier": "009914320", "issuer": null, "state": "AL" }, { "code": "05", "desc": "MEDICAID", "identifier": "0538090", "issuer": null, "state": "IA" }, { "code": "05", "desc": "MEDICAID", "identifier": "100212660A", "issuer": null, "state": "OK" }, { "code": "05", "desc": "MEDICAID", "identifier": "100249680-00", "issuer": null, "state": "NE" }, { "code": "05", "desc": "MEDICAID", "identifier": "104819784", "issuer": null, "state": "MI" }, { "code": "05", "desc": "MEDICAID", "identifier": "1146378 00", "issuer": null, "state": "WY" }, { "code": "05", "desc": "MEDICAID", "identifier": "138470001", "issuer": null, "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "1561789", "issuer": null, "state": "LA" }, { "code": "05", "desc": "MEDICAID", "identifier": "175156201", "issuer": null, "state": "TX" }, { "code": "05", "desc": "MEDICAID", "identifier": "205080906", "issuer": null, "state": "MO" }, { "code": "05", "desc": "MEDICAID", "identifier": "274918", "issuer": null, "state": "OR" }, { "code": "05", "desc": "MEDICAID", "identifier": "3846306", "issuer": null, "state": "TN" }, { "code": "05", "desc": "MEDICAID", "identifier": "422400000", "issuer": null, "state": "ME" }, { "code": "05", "desc": "MEDICAID", "identifier": "64005648", "issuer": null, "state": "KY" }, { "code": "05", "desc": "MEDICAID", "identifier": "6609198", "issuer": null, "state": "VA" }, { "code": "05", "desc": "MEDICAID", "identifier": "7612402", "issuer": null, "state": "NC" } ], "last_updated_epoch": "1747740891000", "number": "1851394985", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "31735", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1068 CRESTHAVEN RD STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381190809", "state": "TN", "telephone_number": "901-866-8864" }, { "address_1": "930 MADISON AVE STE 500", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381033410", "state": "TN", "telephone_number": "901-448-8013" } ], "basic": { "certification_date": "2025-04-03", "credential": "M.D.", "enumeration_date": "2009-04-29", "first_name": "FARRUKH", "last_name": "GILL", "last_updated": "2025-04-03", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1241024092000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1743705646000", "number": "1992949309", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "49164", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "45662", "primary": false, "state": "KY", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "PO BOX 1483", "address_purpose": "MAILING", "address_type": "DOM", "city": "INDIANAPOLIS", "country_code": "US", "country_name": "United States", "fax_number": "317-663-6054", "postal_code": "462061483", "state": "IN", "telephone_number": "317-663-6055" }, { "address_1": "5959 PARK AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-765-2064", "postal_code": "381195200", "state": "TN", "telephone_number": "901-765-2131" } ], "basic": { "credential": "MD", "enumeration_date": "2006-02-15", "first_name": "RAYMOND", "last_name": "GLOTZBACH", "last_updated": "2013-12-11", "middle_name": "E", "name_prefix": "--", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1140040768000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "08177008", "issuer": null, "state": "MS" }, { "code": "05", "desc": "MEDICAID", "identifier": "110551001", "issuer": null, "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "3043912", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1386780666000", "number": "1811961717", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "10333", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1010 AIRPARK CENTER DR", "address_purpose": "MAILING", "address_type": "DOM", "city": "NASHVILLE", "country_code": "US", "country_name": "United States", "postal_code": "372175200", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "6019 WALNUT GROVE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381202113", "state": "TN", "telephone_number": "901-226-5000" } ], "basic": { "certification_date": "2022-09-06", "credential": "D.O.", "enumeration_date": "2013-04-03", "first_name": "ANDREW", "last_name": "GOLDEN", "last_updated": "2022-09-08", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1364963203000", "endpoints": [ { "address_1": "6111 Executive Blvd", "address_type": "DOM", "affiliation": "N", "city": "Rockville", "contentOtherDescription": "C-CDA", "contentType": "OTHER", "contentTypeDescription": "Other", "country_code": "US", "country_name": "United States", "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggat", "endpointDescription": "Carequality", "endpointType": "SOAP", "endpointTypeDescription": "SOAP URL", "postal_code": "208523911", "state": "MD", "use": "HIE", "useDescription": "Health Information Exchange (HIE)" } ], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1662644642000", "number": "1093058570", "other_names": [], "practiceLocations": [ { "address_1": "150 BERGEN ST # UHE-155", "address_purpose": "LOCATION", "address_type": "DOM", "city": "NEWARK", "country_code": "US", "country_name": "United States", "postal_code": "071032496", "state": "NJ", "telephone_number": "973-972-5722" } ], "taxonomies": [ { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "4880", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1010 AIRPARK CENTER DR", "address_purpose": "MAILING", "address_type": "DOM", "city": "NASHVILLE", "country_code": "US", "country_name": "United States", "postal_code": "372175200", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "6019 WALNUT GROVE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381202113", "state": "TN", "telephone_number": "615-221-4400" } ], "basic": { "certification_date": "2021-12-10", "credential": "MD", "enumeration_date": "2006-10-18", "first_name": "CHRISTOPHER", "last_name": "GOLEMBESKI", "last_updated": "2021-12-10", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1161219263000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1639151761000", "number": "1447331897", "other_names": [], "practiceLocations": [ { "address_1": "1255 W WASHINGTON ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "TEMPE", "country_code": "US", "country_name": "United States", "fax_number": "623-889-7407", "postal_code": "852811210", "state": "AZ", "telephone_number": "602-685-5211" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-2606", "postal_code": "38125", "state": "TN", "telephone_number": "901-526-7444" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "36648", "primary": false, "state": "AZ", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "48648", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-271-2606", "postal_code": "38125", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-271-2606", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "credential": "M.D.", "enumeration_date": "2006-03-14", "first_name": "SUSAN", "last_name": "GOODMAN", "last_updated": "2018-10-22", "middle_name": "CATES", "name_prefix": "Dr.", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1142349172000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "01", "desc": "Other (non-Medicare)", "identifier": "106515709", "issuer": "Group Medicaid", "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "149681001", "issuer": null, "state": "AR" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "18019", "issuer": "Group Medicare", "state": "AR" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "406690238", "issuer": "Railroad Medicare", "state": "AR" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "56822", "issuer": "Medicare Professional", "state": "AR" } ], "last_updated_epoch": "1540232895000", "number": "1407824626", "other_names": [], "practiceLocations": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-271-2606", "postal_code": "38125", "state": "TN", "telephone_number": "901-526-7444" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "053916", "primary": false, "state": "GA", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "14091", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "10208", "primary": false, "state": "MS", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "27689", "primary": false, "state": "SC", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "e3528", "primary": false, "state": "AR", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "877 JEFFERSON AVE", "address_2": "ATTN: PROVIDER ENROLLMENT", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381032807", "state": "TN", "telephone_number": "901-545-7558" }, { "address_1": "877 JEFFERSON AVE", "address_2": "CHANDLER BLDG 4TH FLOOR", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381032807", "state": "TN", "telephone_number": "901-545-7558" } ], "basic": { "credential": "M.D.", "enumeration_date": "2007-04-11", "first_name": "SHEFALI", "last_name": "GOYAL", "last_updated": "2015-02-11", "middle_name": "BHUSNURMATH", "name_prefix": "Dr.", "name_suffix": "--", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1176309037000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1423680900000", "number": "1710100367", "other_names": [ { "code": "1", "credential": "M.D.", "first_name": "SHEFALI", "last_name": "BHUSNURMATH", "middle_name": "SHIVAYOGI", "prefix": "--", "suffix": "--", "type": "Former Name" } ], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0101X", "desc": "Pathology, Anatomic Pathology", "license": "MD60164230", "primary": false, "state": "WA", "taxonomy_group": "" }, { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" }, { "code": "207ZP0101X", "desc": "Pathology, Anatomic Pathology", "license": "MD 60164230", "primary": false, "state": "WA", "taxonomy_group": "" }, { "code": "207ZP0101X", "desc": "Pathology, Anatomic Pathology", "license": "01066212A", "primary": false, "state": "IN", "taxonomy_group": "" }, { "code": "207ZP0101X", "desc": "Pathology, Anatomic Pathology", "license": "003386-1", "primary": false, "state": "NY", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "50663", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE STE 330", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381046655", "state": "TN" }, { "address_1": "1265 UNION AVE", "address_2": "DEPT OF PATHOLOGY, 6 SHERARD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38104", "state": "TN", "telephone_number": "901-516-7182" } ], "basic": { "certification_date": "2025-05-01", "credential": "M.D.", "enumeration_date": "2009-03-27", "first_name": "JOEL", "last_name": "GRADOWSKI", "last_updated": "2025-05-13", "middle_name": "FRANCIS", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1238165513000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "102291509", "issuer": null, "state": "PA" } ], "last_updated_epoch": "1747148363000", "number": "1982846630", "other_names": [], "practiceLocations": [ { "address_1": "4250 BETHEL RD DEPT OF", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OLIVE BRANCH", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "386548737", "state": "MS", "telephone_number": "901-516-7182" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MD433029", "primary": false, "state": "PA", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "54602", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "5301 VIRGINIA WAY STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "BRENTWOOD", "country_code": "US", "country_name": "United States", "postal_code": "370277542", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "6019 WALNUT GROVE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381202113", "state": "TN", "telephone_number": "615-221-4400" } ], "basic": { "certification_date": "2024-07-03", "credential": "M.D.", "enumeration_date": "2014-04-15", "first_name": "DANIEL", "last_name": "HALE", "last_updated": "2024-07-03", "middle_name": "ALAN", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1397594864000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1720037037000", "number": "1477972610", "other_names": [], "practiceLocations": [ { "address_1": "9705 LENEXA DR", "address_purpose": "LOCATION", "address_type": "DOM", "city": "LENEXA", "country_code": "US", "country_name": "United States", "fax_number": "816-936-8118", "postal_code": "662151345", "state": "KS", "telephone_number": "816-241-3338" } ], "taxonomies": [ { "code": "207ZH0000X", "desc": "Pathology, Hematology", "license": "04-42115", "primary": false, "state": "KS", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "04-42115", "primary": true, "state": "KS", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" }, { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" } ], "basic": { "credential": "M.D.", "enumeration_date": "2005-12-01", "first_name": "CHARLES", "last_name": "HANDORF", "last_updated": "2007-12-27", "middle_name": "R", "name_prefix": "--", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1133474885000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3040832", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1198775205000", "number": "1174507289", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "010717", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1407 UNION AVE STE 701", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381043641", "state": "TN" }, { "address_1": "877 JEFFERSON AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381032807", "state": "TN", "telephone_number": "901-545-7100" } ], "basic": { "certification_date": "2020-12-17", "credential": "MD", "enumeration_date": "2020-12-17", "first_name": "ANWAR", "last_name": "HAQUE", "last_updated": "2020-12-17", "middle_name": "U", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1608244214000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1608244214000", "number": "1639765191", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "60532", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "5301 VIRGINIA WAY STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "BRENTWOOD", "country_code": "US", "country_name": "United States", "postal_code": "370277542", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "930 MADISON AVE STE 500", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381033410", "state": "TN", "telephone_number": "901-448-7020" } ], "basic": { "certification_date": "2025-11-07", "credential": "M.D", "enumeration_date": "2013-04-09", "first_name": "ZEINAB", "last_name": "HASAN", "last_updated": "2025-11-07", "middle_name": "ABDULJABBAR", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1365552829000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1762533203000", "number": "1205279270", "other_names": [], "practiceLocations": [ { "address_1": "6019 WALNUT GROVE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381202113", "state": "TN", "telephone_number": "901-227-2455" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "50318", "primary": true, "state": "KY", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "59911", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "14275 MIDWAY RD STE 400", "address_purpose": "MAILING", "address_type": "DOM", "city": "ADDISON", "country_code": "US", "country_name": "United States", "postal_code": "750013661", "state": "TX" }, { "address_1": "7485 E TANQUE VERDE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "TUCSON", "country_code": "US", "country_name": "United States", "postal_code": "857153477", "state": "AZ", "telephone_number": "520-320-7681" } ], "basic": { "certification_date": "2024-08-26", "credential": "M.D.", "enumeration_date": "2011-06-14", "first_name": "DANA", "last_name": "HAYDEL", "last_updated": "2024-08-26", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1308110388000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "01", "desc": "Other (non-Medicare)", "identifier": "NN6881A", "issuer": "Medicare", "state": "NC" } ], "last_updated_epoch": "1724697997000", "number": "1588959894", "other_names": [], "practiceLocations": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "16250 NW 59TH AVE STE 201", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MIAMI LAKES", "country_code": "US", "country_name": "United States", "fax_number": "305-779-5387", "postal_code": "330147542", "state": "FL", "telephone_number": "866-825-4422" }, { "address_1": "706 GREEN VALLEY RD STE 104", "address_purpose": "LOCATION", "address_type": "DOM", "city": "GREENSBORO", "country_code": "US", "country_name": "United States", "fax_number": "336-387-2501", "postal_code": "27408", "state": "NC", "telephone_number": "336-387-2500" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "ME138073", "primary": false, "state": "FL", "taxonomy_group": "" }, { "code": "207ND0900X", "desc": "Dermatology, Dermatopathology", "license": "66057", "primary": true, "state": "AZ", "taxonomy_group": "" }, { "code": "207ND0900X", "desc": "Dermatology, Dermatopathology", "license": "ME138073", "primary": false, "state": "FL", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-595-3842", "postal_code": "381053678", "state": "TN", "telephone_number": "901-595-3006" }, { "address_1": "262 DANNY THOMAS PL", "address_2": "MS 515", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-595-3842", "postal_code": "381053678", "state": "TN", "telephone_number": "901-595-3006" } ], "basic": { "certification_date": "2025-01-27", "credential": "MD", "enumeration_date": "2005-05-23", "first_name": "RANDALL", "last_name": "HAYDEN", "last_updated": "2025-01-27", "middle_name": "T", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1116867640000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3859643", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1738006864000", "number": "1992708028", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZM0300X", "desc": "Pathology, Medical Microbiology", "license": "34617", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "34617", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE STE 330", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381046655", "state": "TN" }, { "address_1": "4250 BETHEL RD DEPT OF", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OLIVE BRANCH", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "386548737", "state": "MS", "telephone_number": "901-516-7182" } ], "basic": { "certification_date": "2025-05-02", "credential": "M.D.", "enumeration_date": "2007-05-18", "first_name": "JULIE", "last_name": "HICKS", "last_updated": "2025-05-13", "middle_name": "TREMOR", "name_prefix": "Dr.", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1179504293000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1747150995000", "number": "1003024613", "other_names": [], "practiceLocations": [ { "address_1": "2301 S LAMAR BLVD", "address_2": "JPB PATHOLOGY", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OXFORD", "country_code": "US", "country_name": "United States", "postal_code": "386555373", "state": "MS", "telephone_number": "662-232-8125" }, { "address_1": "1265 UNION AVE", "address_2": "DEPT OF PATHOLOGY, 6 SHERARD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38104", "state": "TN", "telephone_number": "901-516-7182" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "17182", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "M11310", "primary": true, "state": "MS", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1265 UNION AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38104", "state": "TN", "telephone_number": "901-516-7182" }, { "address_1": "PO BOX 603283", "address_purpose": "MAILING", "address_type": "DOM", "city": "CHARLOTTE", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "282603283", "state": "NC", "telephone_number": "901-516-7182" } ], "basic": { "certification_date": "2022-02-03", "credential": "MD", "enumeration_date": "2013-04-11", "first_name": "DEEPTHI", "last_name": "HOSKOPPAL", "last_updated": "2022-07-21", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1365710333000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1658438095000", "number": "1861835571", "other_names": [], "practiceLocations": [ { "address_1": "UNIVERSITY OF TENNESSEE 910 MADISON AVE STE 1031", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381630001", "state": "TN", "telephone_number": "901-448-5364" }, { "address_1": "1161 21ST AVE S", "address_purpose": "LOCATION", "address_type": "DOM", "city": "NASHVILLE", "country_code": "US", "country_name": "United States", "postal_code": "372320001", "state": "TN", "telephone_number": "615-343-4882" }, { "address_1": "1265 UNION AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381043415", "state": "TN", "telephone_number": "240-461-6151" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "55457", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "299437", "primary": true, "state": "NY", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "5301 VIRGINIA WAY STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "BRENTWOOD", "country_code": "US", "country_name": "United States", "postal_code": "370277542", "state": "TN", "telephone_number": "156-221-4400" }, { "address_1": "2124 14TH ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MERIDIAN", "country_code": "US", "country_name": "United States", "postal_code": "393014040", "state": "MS", "telephone_number": "156-221-4400" } ], "basic": { "certification_date": "2024-07-02", "credential": "M.D.", "enumeration_date": "2007-03-14", "first_name": "RALPH", "last_name": "HUGHES", "last_updated": "2024-07-03", "middle_name": "CONDON", "name_prefix": "Dr.", "name_suffix": "III", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1173876221000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "01", "desc": "Other (non-Medicare)", "identifier": "042568", "issuer": "Medical License", "state": "CT" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "060086", "issuer": "Georgia", "state": "GA" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "13669", "issuer": "New Hampshire", "state": "NH" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "14489", "issuer": "Medical License", "state": "OK" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "20291", "issuer": "Mississippi", "state": "MS" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "25900", "issuer": "Medical License", "state": "CO" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "28641", "issuer": "Medical License", "state": "WA" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "30344", "issuer": "South Carolina", "state": "SC" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "34357", "issuer": "Medical License", "state": "NC" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "41240", "issuer": "Kentucky", "state": "KY" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "43117", "issuer": "Tennessee", "state": "TN" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "46798", "issuer": "Medical License", "state": "VA" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "4772", "issuer": "Medical License", "state": "AK" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "82141", "issuer": "Medical License", "state": "OH" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "8325", "issuer": "Medical License", "state": "MT" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "F6770", "issuer": "Medical License", "state": "TX" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "MD201821", "issuer": "Louisiana", "state": "LA" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "MD433475", "issuer": "Pennsylvania", "state": "PA" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "ME89484", "issuer": "Medical License", "state": "FL" } ], "last_updated_epoch": "1720032443000", "number": "1598898967", "other_names": [], "practiceLocations": [ { "address_1": "1512 20TH AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MERIDIAN", "country_code": "US", "country_name": "United States", "fax_number": "601-484-7776", "postal_code": "393014124", "state": "MS", "telephone_number": "601-483-8300" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "taxonomies": [ { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "20291", "primary": false, "state": "MS", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "ME89484", "primary": false, "state": "FL", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "20291", "primary": true, "state": "MS", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1265 UNION AVE", "address_2": "DEPT OF PATHOLOGY, 6 SHERARD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38104", "state": "TN", "telephone_number": "901-516-7182" }, { "address_1": "1211 UNION AVE STE 330", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381046655", "state": "TN" } ], "basic": { "certification_date": "2025-05-01", "credential": "MD", "enumeration_date": "2010-11-11", "first_name": "RICHA", "last_name": "JAIN", "last_updated": "2025-05-13", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1289502142000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1747144499000", "number": "1235430950", "other_names": [], "practiceLocations": [ { "address_1": "4250 BETHEL RD DEPT OF", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OLIVE BRANCH", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "386548737", "state": "MS", "telephone_number": "901-516-7182" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "59497", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "125058987", "primary": false, "state": "IL", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE STE 330", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381046655", "state": "TN" }, { "address_1": "1265 UNION AVE, DEPT OF PATHOLOGY", "address_2": "6 SHERARD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38104", "state": "TN", "telephone_number": "901-516-7182" } ], "basic": { "certification_date": "2025-05-30", "credential": "M.D.", "enumeration_date": "2013-07-09", "first_name": "SARA", "last_name": "JAVIDIPARSIJANI", "last_updated": "2025-06-20", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1373391201000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1750436411000", "number": "1316388143", "other_names": [], "practiceLocations": [ { "address_1": "4250 BETHEL RD, DEPT OF PATHOLOGY", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OLIVE BRANCH", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38654", "state": "MS", "telephone_number": "901-516-7182" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "036143147", "primary": false, "state": "IL", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "53617", "primary": false, "state": "KY", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "66610", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "OF PATHOLOGY AND LABORATORY MEDICINE", "address_2": "930 MADISON AVENUE, RM 518", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-448-6979", "postal_code": "381632243", "state": "TN", "telephone_number": "901-448-6300" }, { "address_1": "OF PATHOLOGY AND LABORATORY MEDICINE", "address_2": "930 MADISON AVENUE, RM 518", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-448-6979", "postal_code": "381632243", "state": "TN", "telephone_number": "901-448-6300" } ], "basic": { "credential": "MD", "enumeration_date": "2005-08-04", "first_name": "CAMEILA", "last_name": "JOHNS", "last_updated": "2008-01-03", "middle_name": "D'SILVA", "name_prefix": "Dr.", "name_suffix": "--", "sex": "F", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1123158295000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "38982261", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1199390198000", "number": "1306847918", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MD38594", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "5959 PARK AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-765-2064", "postal_code": "381195200", "state": "TN", "telephone_number": "901-765-2131" }, { "address_1": "PO BOX 1483", "address_purpose": "MAILING", "address_type": "DOM", "city": "INDIANAPOLIS", "country_code": "US", "country_name": "United States", "postal_code": "462061483", "state": "IN", "telephone_number": "877-262-6446" } ], "basic": { "credential": "MD", "enumeration_date": "2006-11-08", "first_name": "ANNE", "last_name": "JORDAN", "last_updated": "2017-01-31", "middle_name": "M", "name_prefix": "--", "name_suffix": "--", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1163023880000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "113599001", "issuer": null, "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "1525187", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1485892752000", "number": "1881764801", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "17218", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "E1849", "primary": false, "state": "AR", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "4250 BETHEL RD, DEPT OF PATHOLOGY", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OLIVE BRANCH", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38654", "state": "MS", "telephone_number": "901-516-7182" }, { "address_1": "1211 UNION AVE STE 330", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381046655", "state": "TN" } ], "basic": { "certification_date": "2025-05-30", "credential": "M.D.", "enumeration_date": "2011-04-25", "first_name": "MEGAN", "last_name": "KEMPE", "last_updated": "2025-06-18", "middle_name": "HICKS", "name_prefix": "Dr.", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1303745378000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1750272268000", "number": "1184915241", "other_names": [], "practiceLocations": [ { "address_1": "1265 UNION AVE, DEPT OF PATHOLOGY", "address_2": "6 SHERARD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38104", "state": "TN", "telephone_number": "901-516-7182" } ], "taxonomies": [ { "code": "207ZC0500X", "desc": "Pathology, Cytopathology", "license": "24417", "primary": false, "state": "MS", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "66924", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "24417", "primary": true, "state": "MS", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE STE 330", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381046655", "state": "TN" }, { "address_1": "1265 UNION AVE, DEPT OF PATHOLOGY, 6 SHERARD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38104", "state": "TN", "telephone_number": "901-516-7182" } ], "basic": { "certification_date": "2025-05-30", "credential": "MD", "enumeration_date": "2019-02-21", "first_name": "ZEINA", "last_name": "KHAIRY", "last_updated": "2025-05-30", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1550759442000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "01", "desc": "Other (non-Medicare)", "identifier": "85303019", "issuer": "Empire BlueCross", "state": "NY" } ], "last_updated_epoch": "1748638890000", "number": "1205393782", "other_names": [], "practiceLocations": [ { "address_1": "4250 BETHEL RD DEPT OF", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OLIVE BRANCH", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "386548737", "state": "MS", "telephone_number": "901-516-7182" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "65535", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "30253", "primary": false, "state": "MS", "taxonomy_group": "" }, { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1 CRANBERRY HL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "LEXINGTON", "country_code": "US", "country_name": "United States", "fax_number": "205-579-9387", "postal_code": "024217394", "state": "MA", "telephone_number": "678-679-9059" }, { "address_1": "1 CRANBERRY HL", "address_purpose": "MAILING", "address_type": "DOM", "city": "LEXINGTON", "country_code": "US", "country_name": "United States", "fax_number": "205-579-9387", "postal_code": "024217394", "state": "MA", "telephone_number": "678-679-9059" } ], "basic": { "certification_date": "2025-06-03", "credential": "MD", "enumeration_date": "2017-06-08", "first_name": "SHEVA", "last_name": "KHALAFBEIGI", "last_updated": "2025-06-03", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1496960028000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1748970290000", "number": "1114456407", "other_names": [], "practiceLocations": [ { "address_1": "500 UNIVERSITY DRIVE", "address_2": "PENN STATE HEALTH MILTON S. HERSHEY MEDICAL CENTER", "address_purpose": "LOCATION", "address_type": "DOM", "city": "HERSHEY", "country_code": "US", "country_name": "United States", "postal_code": "17033", "state": "PA", "telephone_number": "800-243-1455" }, { "address_1": "7455 W WASHINGTON AVE STE 301", "address_purpose": "LOCATION", "address_type": "DOM", "city": "LAS VEGAS", "country_code": "US", "country_name": "United States", "fax_number": "702-938-9954", "postal_code": "89128", "state": "NV", "telephone_number": "877-562-5227" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "147 W CHUBBUCK RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "CHUBBUCK", "country_code": "US", "country_name": "United States", "fax_number": "208-237-9643", "postal_code": "832022314", "state": "ID", "telephone_number": "208-238-7546" }, { "address_1": "1344 HILAND AVE STE D", "address_purpose": "LOCATION", "address_type": "DOM", "city": "BURLEY", "country_code": "US", "country_name": "United States", "postal_code": "833181564", "state": "ID", "telephone_number": "208-572-6005" }, { "address_1": "1411 FALLS AVE E STE 1002", "address_purpose": "LOCATION", "address_type": "DOM", "city": "TWIN FALLS", "country_code": "US", "country_name": "United States", "postal_code": "833013459", "state": "ID", "telephone_number": "208-595-5424" }, { "address_1": "500 VONDERBURG DR STE 115W", "address_purpose": "LOCATION", "address_type": "DOM", "city": "BRANDON", "country_code": "US", "country_name": "United States", "fax_number": "813-321-1787", "postal_code": "335115969", "state": "FL", "telephone_number": "813-321-1786" } ], "taxonomies": [ { "code": "207ND0900X", "desc": "Dermatology, Dermatopathology", "license": "M-16214", "primary": false, "state": "ID", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "286016", "primary": true, "state": "MA", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "18100", "primary": false, "state": "NV", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "56467", "primary": false, "state": "AZ", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "ME141871", "primary": false, "state": "FL", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "PO BOX 736387", "address_purpose": "MAILING", "address_type": "DOM", "city": "DALLAS", "country_code": "US", "country_name": "United States", "fax_number": "843-410-5519", "postal_code": "753736387", "state": "TX", "telephone_number": "888-490-5457" }, { "address_1": "1265 UNION AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "381043415", "state": "TN", "telephone_number": "901-516-7182" } ], "basic": { "certification_date": "2026-04-28", "credential": "MD", "enumeration_date": "2013-08-23", "first_name": "FARHAN", "last_name": "KHAN", "last_updated": "2026-04-28", "middle_name": "AHMAD", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1377289710000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1777392117000", "number": "1245664416", "other_names": [], "practiceLocations": [ { "address_1": "4250 BETHEL RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OLIVE BRANCH", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "386548737", "state": "MS", "telephone_number": "901-516-7182" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "59281", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "262 DANNY THOMAS PL # MS 515", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN" }, { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN", "telephone_number": "888-226-4343" } ], "basic": { "certification_date": "2025-02-14", "credential": "M.D.", "enumeration_date": "2015-09-05", "first_name": "MAHSA", "last_name": "KHANLARI", "last_updated": "2025-02-14", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1441493955000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1739542834000", "number": "1073981197", "other_names": [], "practiceLocations": [ { "address_1": "1611 NW 12TH AVE FL 33136", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MIAMI", "country_code": "US", "country_name": "United States", "postal_code": "331361005", "state": "FL", "telephone_number": "305-250-8388" } ], "taxonomies": [ { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": "08934077", "primary": false, "state": "FL", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "63228", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "930 MADISON AVE STE 500", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381033410", "state": "TN", "telephone_number": "901-448-8013" }, { "address_1": "1068 CRESTHAVEN RD STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381190809", "state": "TN" } ], "basic": { "certification_date": "2025-02-26", "credential": "MD", "enumeration_date": "2008-04-08", "first_name": "LAUREN", "last_name": "KING", "last_updated": "2025-02-26", "middle_name": "COOPER", "name_prefix": "Dr.", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1207664753000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "03936334", "issuer": null, "state": "MS" }, { "code": "05", "desc": "MEDICAID", "identifier": "Q031052", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1740594140000", "number": "1518130996", "other_names": [ { "code": "1", "first_name": "LAUREN", "last_name": "COOPER", "middle_name": "ROBERTS", "prefix": "Miss", "suffix": "--", "type": "Former Name" } ], "practiceLocations": [ { "address_1": "940 STANTON L YOUNG BLVD BMSB-451", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OKLAHOMA CITY", "country_code": "US", "country_name": "United States", "postal_code": "731045020", "state": "OK", "telephone_number": "405-271-2422" } ], "taxonomies": [ { "code": "207ZH0000X", "desc": "Pathology, Hematology", "license": "31223", "primary": false, "state": "OK", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "31223", "primary": false, "state": "OK", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "49235", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2026-02-05", "credential": "MD", "enumeration_date": "2007-06-11", "first_name": "RICHARD", "last_name": "KINSEY", "last_updated": "2026-02-05", "middle_name": "SHAWN", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1181573133000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "01", "desc": "Other (non-Medicare)", "identifier": "BP1-0017845", "issuer": "INSTITUTIONAL PERMIT", "state": null } ], "last_updated_epoch": "1770324991000", "number": "1659574127", "other_names": [], "practiceLocations": [ { "address_1": "150 COLLINS ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381123814", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "2801 W KINNICKINNIC RIVER PKWY STE 1080", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MILWAUKEE", "country_code": "US", "country_name": "United States", "fax_number": "414-908-6510", "postal_code": "532153689", "state": "WI", "telephone_number": "414-908-6506" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "48729", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "72071-20", "primary": false, "state": "WI", "taxonomy_group": "" }, { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "5959 PARK AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-765-2064", "postal_code": "381195200", "state": "TN", "telephone_number": "901-765-2131" }, { "address_1": "PO BOX 1483", "address_purpose": "MAILING", "address_type": "DOM", "city": "INDIANAPOLIS", "country_code": "US", "country_name": "United States", "fax_number": "317-705-5060", "postal_code": "462061483", "state": "IN", "telephone_number": "877-262-6446" } ], "basic": { "certification_date": "2025-01-14", "credential": "M.D.", "enumeration_date": "2008-02-13", "first_name": "SEAN", "last_name": "KLEPPER", "last_updated": "2025-01-14", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1202916329000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "01", "desc": "Other (non-Medicare)", "identifier": "6007590", "issuer": "BCBS TN", "state": "TN" }, { "code": "05", "desc": "MEDICAID", "identifier": "Q002989", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1736852105000", "number": "1316115397", "other_names": [], "practiceLocations": [ { "address_1": "595 W STATE ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "DOYLESTOWN", "country_code": "US", "country_name": "United States", "fax_number": "215-345-2251", "postal_code": "189012554", "state": "PA", "telephone_number": "215-345-2625" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "225429", "primary": false, "state": "MA", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "35097671", "primary": false, "state": "OH", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MD480134", "primary": false, "state": "PA", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "50645", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN", "telephone_number": "888-226-4343" }, { "address_1": "262 DANNY THOMAS PL # MS 515", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN" } ], "basic": { "certification_date": "2025-02-13", "credential": "MD, PhD", "enumeration_date": "2011-06-21", "first_name": "SELENE", "last_name": "KOO", "last_updated": "2025-02-13", "middle_name": "CLARISSA", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1308699664000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1739464170000", "number": "1205122967", "other_names": [], "practiceLocations": [ { "address_1": "300 LONGWOOD AVE", "address_2": "DEPARTMENT OF PATHOLOGY - BCH 3027", "address_purpose": "LOCATION", "address_type": "DOM", "city": "BOSTON", "country_code": "US", "country_name": "United States", "postal_code": "021155724", "state": "MA", "telephone_number": "617-355-7431" }, { "address_1": "700 CHILDRENS DR RM J0336", "address_purpose": "LOCATION", "address_type": "DOM", "city": "COLUMBUS", "country_code": "US", "country_name": "United States", "postal_code": "432052664", "state": "OH", "telephone_number": "614-722-5315" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "125059369", "primary": false, "state": "IL", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "35.132164", "primary": false, "state": "OH", "taxonomy_group": "" }, { "code": "207ZP0213X", "desc": "Pathology, Pediatric Pathology", "license": "62776", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "62776", "primary": false, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "930 MADISON AVE FL 5", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381037401", "state": "TN", "telephone_number": "901-866-8013" }, { "address_1": "1407 UNION AVE STE 700", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-302-2622", "postal_code": "381043641", "state": "TN", "telephone_number": "901-866-8622" } ], "basic": { "credential": "MD", "enumeration_date": "2018-08-22", "first_name": "NINA", "last_name": "KRASSILNIK", "last_updated": "2018-10-08", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1534968177000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "Q038590", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1539026112000", "number": "1285115840", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "57058", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "321 E 61ST ST RM 110", "address_purpose": "MAILING", "address_type": "DOM", "city": "NEW YORK", "country_code": "US", "country_name": "United States", "postal_code": "100658204", "state": "NY" }, { "address_1": "321 E 61ST ST RM 110", "address_purpose": "LOCATION", "address_type": "DOM", "city": "NEW YORK", "country_code": "US", "country_name": "United States", "postal_code": "100658204", "state": "NY", "telephone_number": "917-384-5295" } ], "basic": { "certification_date": "2025-12-17", "credential": "M.D.", "enumeration_date": "2014-10-27", "first_name": "PRIYADARSHINI", "last_name": "KUMAR", "last_updated": "2025-12-17", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1414427539000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1765986966000", "number": "1770988297", "other_names": [], "practiceLocations": [ { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN", "telephone_number": "888-226-4343" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "59470", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZH0000X", "desc": "Pathology, Hematology", "license": "59470", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "336374", "primary": true, "state": "NY", "taxonomy_group": "" }, { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1265 UNION AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "381043415", "state": "TN", "telephone_number": "901-516-7182" }, { "address_1": "PO BOX 603283", "address_purpose": "MAILING", "address_type": "DOM", "city": "CHARLOTTE", "country_code": "US", "country_name": "United States", "fax_number": "678-459-0526", "postal_code": "282603283", "state": "NC", "telephone_number": "866-789-4893" } ], "basic": { "credential": "M.D.", "enumeration_date": "2013-06-21", "first_name": "SONALI", "last_name": "LANJEWAR", "last_updated": "2018-06-08", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1371837763000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1528487917000", "number": "1053750166", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "57376", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE STE 330", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381046655", "state": "TN" }, { "address_1": "1265 UNION AVE, DEPT OF PATHOLOGY", "address_2": "6 SHERARD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-516-7587", "postal_code": "38104", "state": "TN", "telephone_number": "901-516-7182" } ], "basic": { "certification_date": "2025-04-15", "credential": "M.D.", "enumeration_date": "2009-07-23", "first_name": "RAZVAN", "last_name": "LAPADAT", "last_updated": "2025-04-23", "middle_name": "CIPRIAN", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1248382833000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1745422225000", "number": "1942430921", "other_names": [], "practiceLocations": [ { "address_1": "4250 BETHEL RD, DEPT OF PATHOLOGY", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OLIVE BRANCH", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38654", "state": "MS", "telephone_number": "901-516-7182" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "036128474", "primary": false, "state": "IL", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "29629", "primary": false, "state": "MS", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "64458", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" }, { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" } ], "basic": { "credential": "M.D.", "enumeration_date": "2005-12-02", "first_name": "OLGA", "last_name": "LASATER", "last_updated": "2007-12-27", "middle_name": "E", "name_prefix": "--", "name_suffix": "--", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1133543554000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3040272", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1198775096000", "number": "1902880982", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "017152", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1265 UNION AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "381043415", "state": "TN", "telephone_number": "901-516-7182" }, { "address_1": "1265 UNION AVE", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "381043415", "state": "TN", "telephone_number": "901-516-7182" } ], "basic": { "credential": "MD", "enumeration_date": "2006-10-17", "first_name": "RODOLFO", "last_name": "LAUCIRICA", "last_updated": "2018-10-08", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1161110367000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "1679653075", "issuer": null, "state": "MO" }, { "code": "05", "desc": "MEDICAID", "identifier": "Q033049", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1539028063000", "number": "1679653075", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "19251", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "521 WEST DR", "address_purpose": "MAILING", "address_type": "DOM", "city": "MUNFORD", "country_code": "US", "country_name": "United States", "postal_code": "380586617", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "enumeration_date": "2006-05-28", "first_name": "ROBERT", "last_name": "LAZAR", "last_updated": "2018-02-22", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1148798619000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1519319939000", "number": "1578510293", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MD23934", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "174400000X", "desc": "Specialist", "license": "025276", "primary": false, "state": "CT", "taxonomy_group": "" }, { "code": "174400000X", "desc": "Specialist", "license": "R-4416", "primary": false, "state": "AR", "taxonomy_group": "" }, { "code": "174400000X", "desc": "Specialist", "license": "MD23934", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "025276", "primary": false, "state": "CT", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "R-4416", "primary": false, "state": "AR", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN", "telephone_number": "888-226-4343" }, { "address_1": "262 DANNY THOMAS PL # MS 515", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN" } ], "basic": { "certification_date": "2025-01-23", "credential": "M.D.", "enumeration_date": "2015-04-06", "first_name": "JULIEANN", "last_name": "LEE", "last_updated": "2025-01-23", "middle_name": "CHRISTINE", "name_prefix": "Mrs.", "sex": "F", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1428354702000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1737647291000", "number": "1235524224", "other_names": [ { "code": "1", "first_name": "JULIEANN", "last_name": "DURHAM", "middle_name": "CHRISTINE", "prefix": "--", "suffix": "--", "type": "Former Name" } ], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "63997", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZN0500X", "desc": "Pathology, Neuropathology", "license": "63997", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0101X", "desc": "Pathology, Anatomic Pathology", "license": "63997", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": "CA", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN", "telephone_number": "888-226-4343" }, { "address_1": "262 DANNY THOMAS PL # MS 515", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN" } ], "basic": { "certification_date": "2020-12-15", "credential": "M.D. Ph.D", "enumeration_date": "2011-05-05", "first_name": "YEN-CHUN", "last_name": "LIU", "last_updated": "2020-12-15", "name_prefix": "Dr.", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1304622759000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1608039369000", "number": "1467744664", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZH0000X", "desc": "Pathology, Hematology", "license": "62238", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0007X", "desc": "Pathology, Molecular Genetic Pathology", "license": "62238", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "62238", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2024-08-26", "enumeration_date": "2005-08-02", "first_name": "LYDIA", "last_name": "MAKAPUGAY", "last_updated": "2024-08-26", "middle_name": "MARGARITA", "name_prefix": "Dr.", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1123004483000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "0116363", "issuer": null, "state": "MS" }, { "code": "05", "desc": "MEDICAID", "identifier": "129023001", "issuer": null, "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "3093081", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1724699056000", "number": "1982605820", "other_names": [], "practiceLocations": [ { "address_1": "150 COLLINS ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381123814", "state": "TN", "telephone_number": "901-526-7444" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MDMD25054", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1193 ISLAND PL E", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-577-7392", "postal_code": "381038899", "state": "TN", "telephone_number": "901-577-7390" }, { "address_1": "1030 JEFFERSON AVE.", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-577-7392", "postal_code": "381042193", "state": "TN", "telephone_number": "901-577-7390" } ], "basic": { "credential": "M.D.", "enumeration_date": "2006-08-02", "first_name": "ANTONIO", "last_name": "MARTINEZ", "last_updated": "2007-07-08", "name_prefix": "Dr.", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1154546967000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1183947785000", "number": "1245247147", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MD0000023622", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" }, { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" } ], "basic": { "credential": "M.D.", "enumeration_date": "2005-12-02", "first_name": "KIMBERLY", "last_name": "MASON", "last_updated": "2007-12-27", "middle_name": "W", "name_prefix": "--", "name_suffix": "--", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1133544007000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3858525", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1198775287000", "number": "1427032408", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "033876", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381046638", "state": "TN" }, { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381046638", "state": "TN", "telephone_number": "901-516-8926" } ], "basic": { "credential": "MD", "enumeration_date": "2005-06-14", "first_name": "DAVID", "last_name": "MCGREGOR", "last_updated": "2007-12-27", "middle_name": "KENJI", "name_prefix": "Dr.", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1118774591000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3334036", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1198774679000", "number": "1689679912", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "L3392", "primary": true, "state": "TX", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" }, { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" } ], "basic": { "credential": "M.D.", "enumeration_date": "2005-12-02", "first_name": "RICHARD", "last_name": "MCLENDON", "last_updated": "2007-12-27", "middle_name": "E", "name_prefix": "--", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1133554562000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3041189", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1198775305000", "number": "1265416200", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "011132", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 875", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "381046638", "state": "TN", "telephone_number": "901-516-7182" }, { "address_1": "1211 UNION AVE", "address_2": "SUITE 875", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "381046638", "state": "TN", "telephone_number": "901-516-7182" } ], "basic": { "authorized_official_credential": "MD", "authorized_official_first_name": "HOLLY", "authorized_official_last_name": "HILSENBECK", "authorized_official_middle_name": "LYNNE", "authorized_official_name_prefix": "--", "authorized_official_name_suffix": "--", "authorized_official_telephone_number": "9015167182", "authorized_official_title_or_position": "President", "enumeration_date": "2015-08-04", "last_updated": "2015-08-04", "organization_name": "MEMPHIS PATHOLOGY GROUP PC", "organizational_subpart": "NO", "status": "A" }, "created_epoch": "1438720127000", "endpoints": [], "enumeration_type": "NPI-2", "identifiers": [], "last_updated_epoch": "1438720127000", "number": "1033595731", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": null, "primary": true, "state": null, "taxonomy_group": "193400000X - Single Specialty Group" } ] }, { "addresses": [ { "address_1": "5301 VIRGINIA WAY STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "BRENTWOOD", "country_code": "US", "country_name": "United States", "postal_code": "370277542", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "7601 SOUTHCREST PKWY", "address_purpose": "LOCATION", "address_type": "DOM", "city": "SOUTHAVEN", "country_code": "US", "country_name": "United States", "postal_code": "386714739", "state": "MS", "telephone_number": "901-227-5135" } ], "basic": { "certification_date": "2025-05-08", "enumeration_date": "2015-07-29", "first_name": "FATIMA", "last_name": "MIR", "last_updated": "2025-05-08", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1438175436000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1746727052000", "number": "1548645799", "other_names": [], "practiceLocations": [ { "address_1": "1653 W. CONGRESS PARKWAY", "address_2": "RUSH UNIVERSITY MEDICAL CENTER", "address_purpose": "LOCATION", "address_type": "DOM", "city": "CHICAGO", "country_code": "US", "country_name": "United States", "postal_code": "60612", "state": "IL", "telephone_number": "312-942-5495" }, { "address_1": "9500 EUCLID AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "CLEVELAND", "country_code": "US", "country_name": "United States", "postal_code": "441950001", "state": "OH", "telephone_number": "216-444-2200" }, { "address_1": "877 JEFFERSON AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-302-2067", "postal_code": "381032807", "state": "TN", "telephone_number": "901-545-7514" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "125066342", "primary": false, "state": "IL", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "63738", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "35126", "primary": true, "state": "MS", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "6201 GREENLEIGH AVE", "address_purpose": "MAILING", "address_type": "DOM", "city": "MIDDLE RIVER", "country_code": "US", "country_name": "United States", "postal_code": "212202004", "state": "MD", "telephone_number": "410-933-6423" }, { "address_1": "1800 ORLEANS ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "BALTIMORE", "country_code": "US", "country_name": "United States", "fax_number": "410-955-0737", "postal_code": "212870010", "state": "MD", "telephone_number": "410-502-2037" } ], "basic": { "certification_date": "2024-05-06", "credential": "MD", "enumeration_date": "2020-03-27", "first_name": "SANOBAR YASMEEN", "last_name": "MOHAMMED", "last_updated": "2024-05-06", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1585352258000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1715005817000", "number": "1497383350", "other_names": [], "practiceLocations": [ { "address_1": "UNIVERSITY OF TENNESSEE 920 MADISON AVENUE SUITE 447", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381630001", "state": "TN", "telephone_number": "901-448-6344" }, { "address_1": "2B, SOUTH TOWER,52 W.UNDERWOOD STREET", "address_purpose": "LOCATION", "address_type": "DOM", "city": "ORLANDO", "country_code": "US", "country_name": "United States", "postal_code": "32806", "state": "FL", "telephone_number": "321-841-8933" }, { "address_1": "4940 EASTERN AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "BALTIMORE", "country_code": "US", "country_name": "United States", "fax_number": "410-550-0470", "postal_code": "212242735", "state": "MD", "telephone_number": "410-550-5568" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "D0098977", "primary": true, "state": "MD", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2023-02-21", "credential": "MD", "enumeration_date": "2005-08-04", "first_name": "LAURA", "last_name": "MOODY", "last_updated": "2023-02-21", "middle_name": "OSBORN", "name_prefix": "Dr.", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1123173433000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1677010647000", "number": "1265433890", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MD31880", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2024-11-22", "credential": "MD, PhD", "enumeration_date": "2006-04-12", "first_name": "XIAO", "last_name": "MU", "last_updated": "2024-11-22", "middle_name": "C", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1144876040000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1732304536000", "number": "1962466565", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "37428", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MD0000037428", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "7550 WOLF RIVER BLVD STE 200", "address_purpose": "LOCATION", "address_type": "DOM", "city": "GERMANTOWN", "country_code": "US", "country_name": "United States", "fax_number": "901-542-6869", "postal_code": "38138", "state": "TN", "telephone_number": "901-542-6838" }, { "address_1": "7550 WOLF RIVER BLVD STE 200", "address_purpose": "MAILING", "address_type": "DOM", "city": "GERMANTOWN", "country_code": "US", "country_name": "United States", "fax_number": "901-542-6869", "postal_code": "381381778", "state": "TN", "telephone_number": "901-542-6838" } ], "basic": { "credential": "D.O.", "enumeration_date": "2014-04-02", "first_name": "GLENN", "last_name": "MURRAY", "last_updated": "2019-06-19", "middle_name": "PAUL", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1396485348000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1560999390000", "number": "1669890935", "other_names": [], "practiceLocations": [ { "address_1": "3628 OAKLEY AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381116153", "state": "TN", "telephone_number": "586-381-9896" }, { "address_1": "4301 W MARKHAM ST # 517", "address_purpose": "LOCATION", "address_type": "DOM", "city": "LITTLE ROCK", "country_code": "US", "country_name": "United States", "postal_code": "72205", "state": "AR", "telephone_number": "586-381-9896" } ], "taxonomies": [ { "code": "207ZH0000X", "desc": "Pathology, Hematology", "license": "DO3310", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "DO3310", "primary": true, "state": "TN", "taxonomy_group": "193400000X - Single Specialty Group" } ] }, { "addresses": [ { "address_1": "5301 VIRGINIA WAY STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "BRENTWOOD", "country_code": "US", "country_name": "United States", "postal_code": "370277542", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "6019 WALNUT GROVE RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381202113", "state": "TN", "telephone_number": "901-227-5135" } ], "basic": { "certification_date": "2024-06-06", "credential": "M.D.", "enumeration_date": "2014-06-12", "first_name": "MUFADDAL", "last_name": "NAJMUDDIN", "last_updated": "2024-06-06", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1402626304000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "200028882", "issuer": null, "state": "MO" } ], "last_updated_epoch": "1717697445000", "number": "1053725564", "other_names": [], "practiceLocations": [ { "address_1": "300 PORTLAND ST STE 110", "address_purpose": "LOCATION", "address_type": "DOM", "city": "COLUMBIA", "country_code": "US", "country_name": "United States", "fax_number": "573-886-4695", "postal_code": "652017390", "state": "MO", "telephone_number": "573-886-4600" }, { "address_1": "41 MALL RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "BURLINGTON", "country_code": "US", "country_name": "United States", "postal_code": "018057390", "state": "MA", "telephone_number": "781-744-8000" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "1017354", "primary": false, "state": "MA", "taxonomy_group": "" }, { "code": "207ZC0500X", "desc": "Pathology, Cytopathology", "license": "2019032201", "primary": false, "state": "MO", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "2019032201", "primary": false, "state": "MO", "taxonomy_group": "" }, { "code": "207ZP0101X", "desc": "Pathology, Anatomic Pathology", "license": "71126", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1010 AIRPARK CENTER DR", "address_purpose": "MAILING", "address_type": "DOM", "city": "NASHVILLE", "country_code": "US", "country_name": "United States", "postal_code": "372175200", "state": "TN", "telephone_number": "615-221-4400" }, { "address_1": "6225 HUMPHREYS BLVD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381202373", "state": "TN", "telephone_number": "615-221-4400" } ], "basic": { "certification_date": "2021-12-06", "credential": "M.D.", "enumeration_date": "2014-06-11", "first_name": "CHARLES", "last_name": "NEWMAN", "last_updated": "2021-12-06", "middle_name": "NEWTON", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1402521557000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "01", "desc": "Other (non-Medicare)", "identifier": "60454", "issuer": "Pathology", "state": "TN" } ], "last_updated_epoch": "1638823823000", "number": "1528472180", "other_names": [], "practiceLocations": [ { "address_1": "7550 WOLF RIVER BLVD STE 200", "address_purpose": "LOCATION", "address_type": "DOM", "city": "GERMANTOWN", "country_code": "US", "country_name": "United States", "postal_code": "381381778", "state": "TN", "telephone_number": "843-792-1086" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "60454", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN", "telephone_number": "888-226-4343" }, { "address_1": "262 DANNY THOMAS PL # MS 515", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN" } ], "basic": { "certification_date": "2023-12-26", "credential": "MD", "enumeration_date": "2019-04-23", "first_name": "DENIS CHAMBERLAIN", "last_name": "NOUBOUOSSIE FONDJIE", "last_updated": "2024-01-05", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1556046550000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1704493989000", "number": "1902460223", "other_names": [], "practiceLocations": [ { "address_1": "625 19TH ST S", "address_purpose": "LOCATION", "address_type": "DOM", "city": "BIRMINGHAM", "country_code": "US", "country_name": "United States", "postal_code": "352331900", "state": "AL", "telephone_number": "205-975-7840" } ], "taxonomies": [ { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "68780", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2024-08-26", "credential": "M.D.", "enumeration_date": "2005-12-07", "first_name": "THOMAS", "last_name": "O'BRIEN", "last_updated": "2024-08-26", "middle_name": "F", "name_suffix": "Jr.", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1133961809000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3061998", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1724696060000", "number": "1336124973", "other_names": [], "practiceLocations": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "018290", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "4548 BRAINERD RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "CHATTANOOGA", "country_code": "US", "country_name": "United States", "fax_number": "423-531-7502", "postal_code": "374115442", "state": "TN", "telephone_number": "423-521-1100" }, { "address_1": "4548 BRAINERD RD STE 102", "address_purpose": "MAILING", "address_type": "DOM", "city": "CHATTANOOGA", "country_code": "US", "country_name": "United States", "fax_number": "423-531-7502", "postal_code": "374115440", "state": "TN", "telephone_number": "423-521-1100" } ], "basic": { "certification_date": "2024-08-26", "credential": "M.D.", "enumeration_date": "2006-12-19", "first_name": "SHIMON", "last_name": "OAMI", "last_updated": "2024-08-26", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1166586478000", "endpoints": [ { "address_1": "4548 Brainerd Rd", "address_type": "DOM", "affiliation": "Y", "affiliationName": "Skin Cancer & Cosmetic Dermatology Center, PC", "city": "Chattanooga", "contentTypeDescription": "", "country_code": "US", "country_name": "United States", "endpoint": "jychung@directaddress.net", "endpointType": "DIRECT", "endpointTypeDescription": "Direct Messaging Address", "postal_code": "374115442", "state": "TN", "useDescription": "" }, { "address_1": "1107 Memorial Drive", "address_2": "Suite 201", "address_type": "DOM", "affiliation": "Y", "affiliationName": "Skin Cancer & Cosmetic Dermatology Center, PC", "city": "Dalton", "contentTypeDescription": "", "country_code": "US", "country_name": "United States", "endpoint": "jychung@directaddress.net", "endpointType": "DIRECT", "endpointTypeDescription": "Direct Messaging Address", "postal_code": "30720", "state": "GA", "useDescription": "" } ], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1724700098000", "number": "1831253640", "other_names": [], "practiceLocations": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "taxonomies": [ { "code": "207ZC0500X", "desc": "Pathology, Cytopathology", "license": "ME0084307", "primary": false, "state": "FL", "taxonomy_group": "" }, { "code": "207ZC0500X", "desc": "Pathology, Cytopathology", "license": "046797", "primary": false, "state": "GA", "taxonomy_group": "" }, { "code": "207ZC0500X", "desc": "Pathology, Cytopathology", "license": "25MA07712800", "primary": false, "state": "NJ", "taxonomy_group": "" }, { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "ME0084307", "primary": false, "state": "FL", "taxonomy_group": "" }, { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "25MA07712800", "primary": false, "state": "NJ", "taxonomy_group": "" }, { "code": "207ZC0500X", "desc": "Pathology, Cytopathology", "license": "192231", "primary": false, "state": "NY", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "046797", "primary": false, "state": "GA", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "ME0084307", "primary": false, "state": "FL", "taxonomy_group": "" }, { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "192231", "primary": false, "state": "NY", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "25MA07712800", "primary": false, "state": "NJ", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "192231", "primary": false, "state": "NY", "taxonomy_group": "" }, { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "046797", "primary": true, "state": "GA", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "38125", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-2606", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2020-06-02", "credential": "M.D.", "enumeration_date": "2008-01-29", "first_name": "CHUKWUMA", "last_name": "ONYEAGOCHA", "last_updated": "2020-06-02", "middle_name": "ONWUMERE", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1201634743000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1591120197000", "number": "1942487251", "other_names": [], "practiceLocations": [ { "address_1": "1364 CLIFTON RD NE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "ATLANTA", "country_code": "US", "country_name": "United States", "postal_code": "303221064", "state": "GA", "telephone_number": "404-727-4283" } ], "taxonomies": [ { "code": "207ZP0101X", "desc": "Pathology, Anatomic Pathology", "license": "002694", "primary": false, "state": "GA", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "46700", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "credential": "MD", "enumeration_date": "2005-08-02", "first_name": "FRANK", "last_name": "OSBORN", "last_updated": "2018-03-17", "middle_name": "DAVID", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1123006519000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "0120249", "issuer": null, "state": "MS" }, { "code": "05", "desc": "MEDICAID", "identifier": "136407001", "issuer": null, "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "3825121", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1521292439000", "number": "1083615942", "other_names": [], "practiceLocations": [ { "address_1": "150 COLLINS ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381123814", "state": "TN", "telephone_number": "901-526-7444" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MD24910", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "877 JEFFERSON AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "38103", "state": "TN", "telephone_number": "901-545-7513" }, { "address_1": "1068 CRESTHAVEN RD STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381190809", "state": "TN" } ], "basic": { "certification_date": "2025-02-26", "credential": "M.D", "enumeration_date": "2014-01-03", "first_name": "TWISHA", "last_name": "OZA", "last_updated": "2025-02-26", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1388759679000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1740594467000", "number": "1417378845", "other_names": [], "practiceLocations": [ { "address_1": "450 CLARKSON AVENUE ,", "address_2": "SUNY DOWNSTATE MEDICAL CENTER", "address_purpose": "LOCATION", "address_type": "DOM", "city": "BROOKLYN", "country_code": "US", "country_name": "United States", "postal_code": "112032098", "state": "NY", "telephone_number": "718-270-8173" }, { "address_1": "877 JEFFERSON AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "38103", "state": "TN", "telephone_number": "901-545-7513" } ], "taxonomies": [ { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "59452", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1030 JEFFERSON AVENUE", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "38104", "state": "TN", "telephone_number": "270-444-2367" }, { "address_1": "1030 JEFFERSON AVENUE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "38104", "state": "TN", "telephone_number": "901-577-7284" } ], "basic": { "credential": "MD", "enumeration_date": "2007-12-21", "first_name": "EUGENE", "last_name": "PEARLMAN", "last_updated": "2010-07-23", "middle_name": "STANLEY", "name_prefix": "--", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1198272861000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1279898989000", "number": "1508040866", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0105X", "desc": "Pathology, Clinical Pathology/Laboratory Medicine", "license": "234424", "primary": false, "state": "MA", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "234424", "primary": true, "state": "MA", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1701 CENTURY CENTER CV", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381348975", "state": "TN", "telephone_number": "901-405-8200" }, { "address_1": "1701 CENTURY CENTER CV", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381348975", "state": "TN", "telephone_number": "901-405-8200" } ], "basic": { "certification_date": "2025-03-24", "credential": "M.D.", "enumeration_date": "2006-07-16", "first_name": "HOLLY", "last_name": "PIERCE", "last_updated": "2025-03-24", "middle_name": "HILSENBECK", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1153080319000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3000088", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1742843019000", "number": "1306863212", "other_names": [ { "code": "1", "first_name": "HOLLY", "last_name": "HILSENBECK", "middle_name": "LYNNE", "prefix": "--", "suffix": "--", "type": "Former Name" } ], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "25977", "primary": false, "state": "AL", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "24789", "primary": false, "state": "OK", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "42224", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "4861 SHADY GROVE RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-683-3750", "postal_code": "381173327", "state": "TN", "telephone_number": "901-683-3750" }, { "address_1": "2301 S LAMAR BLVD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OXFORD", "country_code": "US", "country_name": "United States", "fax_number": "662-236-5236", "postal_code": "38655", "state": "MS", "telephone_number": "662-232-8121" } ], "basic": { "credential": "M.D.", "enumeration_date": "2006-07-28", "first_name": "WILLIAM", "last_name": "POSTON", "last_updated": "2007-07-08", "middle_name": "MASON", "name_prefix": "Dr.", "name_suffix": "--", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1154121275000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1183947785000", "number": "1083628689", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "12683", "primary": true, "state": "MS", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3400 OLENTANGY RIVER RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "COLUMBUS", "country_code": "US", "country_name": "United States", "fax_number": "614-754-5501", "postal_code": "432021523", "state": "OH", "telephone_number": "614-754-5500" }, { "address_1": "3400 OLENTANGY RIVER RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "COLUMBUS", "country_code": "US", "country_name": "United States", "fax_number": "614-754-5501", "postal_code": "432021523", "state": "OH", "telephone_number": "614-754-5500" } ], "basic": { "certification_date": "2024-01-03", "credential": "M.D.", "enumeration_date": "2007-04-18", "first_name": "JULIANNE", "last_name": "PURDY", "last_updated": "2024-01-03", "middle_name": "KRISTIN", "name_prefix": "Dr.", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1176945792000", "endpoints": [ { "address_1": "3400 Olentangy River Rd", "address_type": "DOM", "affiliation": "N", "city": "Columbus", "contentTypeDescription": "", "country_code": "US", "country_name": "United States", "endpoint": "ohio.gastro@directaddress.net", "endpointDescription": "Direct Messaging Address", "endpointType": "DIRECT", "endpointTypeDescription": "Direct Messaging Address", "postal_code": "432021523", "state": "OH", "use": "DIRECT", "useDescription": "Direct" } ], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1704312735000", "number": "1083831689", "other_names": [], "practiceLocations": [ { "address_1": "1500 EAST MEDICAL CENTER DR", "address_2": "2ND FLOOR UNIVERSITY HOSPITAL RECP PATHOLOGY", "address_purpose": "LOCATION", "address_type": "DOM", "city": "ANN ARBOR", "country_code": "US", "country_name": "United States", "postal_code": "481095054", "state": "MI", "telephone_number": "800-862-7284" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "38125", "state": "TN", "telephone_number": "901-526-7444" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "4301086448", "primary": false, "state": "MI", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "45946", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "38125", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2024-08-26", "credential": "M.D.", "enumeration_date": "2006-12-20", "first_name": "HAR", "last_name": "RAI", "last_updated": "2024-08-26", "middle_name": "PRATAP", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1166637329000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1724699260000", "number": "1184788747", "other_names": [], "practiceLocations": [ { "address_1": "4700 LAS VEGAS BLVD N", "address_2": "DEPARTMENT OF PATHOLOGY", "address_purpose": "LOCATION", "address_type": "DOM", "city": "LAS VEGAS", "country_code": "US", "country_name": "United States", "postal_code": "891916600", "state": "NV", "telephone_number": "702-653-2810" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "43954", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" }, { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" } ], "basic": { "credential": "M.D.", "enumeration_date": "2005-12-02", "first_name": "EDWIN", "last_name": "RAINES", "last_updated": "2007-12-27", "middle_name": "A", "name_prefix": "--", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1133556159000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3041510", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1198774904000", "number": "1811971856", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "007545", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "930 MADISON AVE", "address_2": "SUITE 890", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-302-2834", "postal_code": "381033410", "state": "TN", "telephone_number": "901-866-8834" }, { "address_1": "1068 CRESTHAVEN RD STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381190809", "state": "TN" } ], "basic": { "certification_date": "2025-02-25", "credential": "M.D.", "enumeration_date": "2005-12-02", "first_name": "M.", "last_name": "RANDALL", "last_updated": "2025-02-25", "middle_name": "BARRY", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1133557401000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "0121423", "issuer": null, "state": "MS" }, { "code": "05", "desc": "MEDICAID", "identifier": "133395001", "issuer": null, "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "1532078", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1740493239000", "number": "1124002175", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "29321", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "29321", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2024-08-26", "credential": "M.D.", "enumeration_date": "2008-06-02", "first_name": "RICHARD", "last_name": "ROBERTS", "last_updated": "2024-08-26", "middle_name": "LOWELL", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1212438114000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1724699471000", "number": "1235398637", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MD0000037966", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "250 N SHADELAND AVE", "address_purpose": "MAILING", "address_type": "DOM", "city": "INDIANAPOLIS", "country_code": "US", "country_name": "United States", "postal_code": "462194959", "state": "IN" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2025-09-16", "credential": "MD", "enumeration_date": "2006-01-11", "first_name": "ARLENE", "last_name": "ROSENBERG", "last_updated": "2025-09-16", "middle_name": "SYLVIA", "name_prefix": "--", "name_suffix": "--", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1136989538000", "endpoints": [ { "address_1": "2500 Metrohealth Dr", "address_type": "DOM", "affiliation": "N", "city": "Cleveland", "contentTypeDescription": "", "country_code": "US", "country_name": "United States", "endpoint": "arosenberg5120@direct.metrohealth.org", "endpointType": "DIRECT", "endpointTypeDescription": "Direct Messaging Address", "postal_code": "441091900", "state": "OH", "useDescription": "" }, { "address_1": "350 W 11th St", "address_type": "DOM", "affiliation": "N", "city": "Indianapolis", "contentTypeDescription": "", "country_code": "US", "country_name": "United States", "endpoint": "arosenberg@direct.iuhealth.org", "endpointType": "DIRECT", "endpointTypeDescription": "Direct Messaging Address", "postal_code": "462024108", "state": "IN", "use": "DIRECT", "useDescription": "Direct" } ], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "2415701", "issuer": null, "state": "OH" } ], "last_updated_epoch": "1758043247000", "number": "1215916051", "other_names": [], "practiceLocations": [ { "address_1": "2500 METROHEALTH DR", "address_purpose": "LOCATION", "address_type": "DOM", "city": "CLEVELAND", "country_code": "US", "country_name": "United States", "postal_code": "441091900", "state": "OH", "telephone_number": "216-778-7800" }, { "address_1": "350 W 11TH ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "INDIANAPOLIS", "country_code": "US", "country_name": "United States", "postal_code": "462024108", "state": "IN", "telephone_number": "317-491-6000" }, { "address_1": "350 W 11TH ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "INDIANAPOLIS", "country_code": "US", "country_name": "United States", "postal_code": "462024108", "state": "IN", "telephone_number": "317-274-8157" } ], "taxonomies": [ { "code": "207ND0900X", "desc": "Dermatology, Dermatopathology", "license": "01095781A", "primary": false, "state": "IN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "01095781A", "primary": false, "state": "IN", "taxonomy_group": "" }, { "code": "207ND0900X", "desc": "Dermatology, Dermatopathology", "license": "35082855", "primary": true, "state": "OH", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2024-08-26", "credential": "M.D.", "enumeration_date": "2005-12-06", "first_name": "JEFFREY", "last_name": "ROUX", "last_updated": "2024-08-26", "middle_name": "J", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1133882647000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3330957", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1724697324000", "number": "1457335150", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "039728", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1 FORD PL STE 3A", "address_purpose": "MAILING", "address_type": "DOM", "city": "DETROIT", "country_code": "US", "country_name": "United States", "fax_number": "313-876-1305", "postal_code": "482023450", "state": "MI", "telephone_number": "313-874-4806" }, { "address_1": "2799 W GRAND BLVD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "DETROIT", "country_code": "US", "country_name": "United States", "fax_number": "313-916-9113", "postal_code": "482022608", "state": "MI", "telephone_number": "313-916-2357" } ], "basic": { "certification_date": "2026-06-11", "credential": "MD", "enumeration_date": "2013-03-27", "first_name": "NAGLA", "last_name": "SALEM", "last_updated": "2026-06-11", "middle_name": "ELSAYED", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1364427116000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1781173318000", "number": "1366785396", "other_names": [], "practiceLocations": [ { "address_1": "1265 UNION AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "381043415", "state": "TN", "telephone_number": "901-516-7182" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "4301103323", "primary": true, "state": "MI", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "59487", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZH0000X", "desc": "Pathology, Hematology", "license": "4301103323", "primary": false, "state": "MI", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "262 DANNY THOMAS PL", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN", "telephone_number": "901-595-4123" }, { "address_1": "262 DANNY THOMAS PL", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381053678", "state": "TN", "telephone_number": "901-595-4123" } ], "basic": { "credential": "M.D.", "enumeration_date": "2009-04-23", "first_name": "TERESA", "last_name": "SANTIAGO", "last_updated": "2014-06-06", "middle_name": "CRISTINA", "name_prefix": "Dr.", "name_suffix": "--", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1240542848000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1402071088000", "number": "1205070075", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "49540", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1265 UNION AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "381043415", "state": "TN", "telephone_number": "901-516-7182" }, { "address_1": "930 MADISON AVENUE SUITE 500", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "381630001", "state": "TN", "telephone_number": "901-516-7182" } ], "basic": { "credential": "M.D.", "enumeration_date": "2012-04-06", "first_name": "KINJAL", "last_name": "SHAH", "last_updated": "2018-03-28", "middle_name": "SUNILKUMAR", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1333729120000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "00031784", "issuer": null, "state": "MS" }, { "code": "01", "desc": "Other (non-Medicare)", "identifier": "6133336", "issuer": "BCBS", "state": "TN" }, { "code": "05", "desc": "MEDICAID", "identifier": "Q032935", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1522268508000", "number": "1861758559", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "56303", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "877 JEFFERSON AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-545-8122", "postal_code": "381032807", "state": "TN", "telephone_number": "901-545-8336" }, { "address_1": "877 JEFFERSON AVE", "address_2": "ATTN: PROVIDER ENROLLMENT", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-545-8122", "postal_code": "381032807", "state": "TN", "telephone_number": "901-545-6286" } ], "basic": { "authorized_official_first_name": "JAMES", "authorized_official_last_name": "PROCTOR", "authorized_official_telephone_number": "9015458254", "authorized_official_title_or_position": "Chief Financial Officer", "certification_date": "2025-08-20", "enumeration_date": "2005-08-02", "last_updated": "2025-08-20", "organization_name": "SHELBY COUNTY HEALTH CARE CORPORATION", "organizational_subpart": "NO", "status": "A" }, "created_epoch": "1122991615000", "endpoints": [], "enumeration_type": "NPI-2", "identifiers": [], "last_updated_epoch": "1755696348000", "number": "1780685750", "other_names": [], "practiceLocations": [ { "address_1": "1588 UNION AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-685-9718", "postal_code": "381043729", "state": "TN", "telephone_number": "901-623-0055" } ], "taxonomies": [ { "code": "207RH0003X", "desc": "Internal Medicine, Hematology & Oncology", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "207RX0202X", "desc": "Internal Medicine, Medical Oncology", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "207VX0201X", "desc": "Obstetrics & Gynecology, Gynecologic Oncology", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "2085R0202X", "desc": "Radiology, Diagnostic Radiology", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "261QP2300X", "desc": "Clinic/Center, Primary Care", "license": null, "primary": false, "state": null, "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": null, "primary": true, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2020-06-02", "credential": "M.D.", "enumeration_date": "2005-12-05", "first_name": "CRISTINA", "last_name": "SHIMEK", "last_updated": "2020-06-02", "middle_name": "M", "name_prefix": "--", "name_suffix": "--", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1133817545000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3865794", "issuer": null, "state": "TN" }, { "code": "05", "desc": "MEDICAID", "identifier": "Q003503", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1591120815000", "number": "1316921141", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "035165", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" }, { "address_1": "930 MADISON AVE", "address_2": "SUITE 500", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381033410", "state": "TN", "telephone_number": "901-725-7551" } ], "basic": { "credential": "M.D.", "enumeration_date": "2008-02-26", "first_name": "ANDRZEJ", "last_name": "SLOMINSKI", "last_updated": "2014-03-05", "middle_name": "T", "name_prefix": "Dr.", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1204061652000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1394035181000", "number": "1013186873", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "34451", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" }, { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" } ], "basic": { "credential": "M.D.", "enumeration_date": "2005-12-06", "first_name": "A", "last_name": "SOLLEE", "last_updated": "2007-12-27", "middle_name": "NEYLE", "name_prefix": "--", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1133879845000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3885622", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1198775343000", "number": "1114901808", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "006377", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "2555 PONCE DE LEON BLVD", "address_2": "4TH FLOOR", "address_purpose": "MAILING", "address_type": "DOM", "city": "CORAL GABLES", "country_code": "US", "country_name": "United States", "fax_number": "305-441-2144", "postal_code": "33134", "state": "FL", "telephone_number": "305-702-5135" }, { "address_1": "5959 PARK AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-765-2064", "postal_code": "38119", "state": "TN", "telephone_number": "901-765-2131" } ], "basic": { "credential": "MD", "enumeration_date": "2006-02-15", "first_name": "RONALD", "last_name": "STOCKSTILL", "last_updated": "2007-07-08", "middle_name": "G", "name_prefix": "Dr.", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1140026265000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3141666", "issuer": null, "state": "FL" } ], "last_updated_epoch": "1183947785000", "number": "1942274006", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "13933", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "395 S HIGHLAND ST APT 436", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381111625", "state": "TN", "telephone_number": "757-814-4401" }, { "address_1": "1602 SKIPWITH RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "RICHMOND", "country_code": "US", "country_name": "United States", "fax_number": "804-200-7025", "postal_code": "232295205", "state": "VA", "telephone_number": "804-289-4852" } ], "basic": { "certification_date": "2025-10-14", "credential": "MD", "enumeration_date": "2020-05-28", "first_name": "SAMI", "last_name": "TALIBI", "last_updated": "2025-10-14", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1590687872000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1760493620000", "number": "1457974149", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "0101281344", "primary": true, "state": "VA", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "888-244-7284" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "888-244-7284" } ], "basic": { "certification_date": "2024-08-26", "credential": "D.O.", "enumeration_date": "2007-06-01", "first_name": "JOSHUA", "last_name": "TENNENBAUM", "last_updated": "2024-08-26", "middle_name": "B", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1180723201000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1724697536000", "number": "1356543441", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "005451", "primary": false, "state": "AZ", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "2OA8899", "primary": true, "state": "CA", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "5959 PARK AVE", "address_2": "ATTN: PATHOLOGY DEPT", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-765-2064", "postal_code": "381195200", "state": "TN", "telephone_number": "901-765-2731" }, { "address_1": "120 LEHANE TER APT 219", "address_purpose": "MAILING", "address_type": "DOM", "city": "NORTH PALM BEACH", "country_code": "US", "country_name": "United States", "fax_number": "305-692-0884", "postal_code": "334085622", "state": "FL", "telephone_number": "305-798-2064" } ], "basic": { "authorized_official_first_name": "JAMES", "authorized_official_last_name": "HERALD", "authorized_official_middle_name": "P", "authorized_official_telephone_number": "3057982064", "authorized_official_title_or_position": "Billing manager", "certification_date": "2022-03-22", "enumeration_date": "2006-02-15", "last_updated": "2022-03-22", "organization_name": "THE PATHOLOGY GROUP PC", "organizational_subpart": "NO", "status": "A" }, "created_epoch": "1140027606000", "endpoints": [], "enumeration_type": "NPI-2", "identifiers": [], "last_updated_epoch": "1647977961000", "number": "1679547749", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": null, "primary": true, "state": null, "taxonomy_group": "193400000X - Single Specialty Group" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE STE 330", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381046655", "state": "TN" }, { "address_1": "1265 UNION AVE, DEPT OF PATHOLOGY", "address_2": "6 SHERARD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38104", "state": "TN", "telephone_number": "901-516-7182" } ], "basic": { "certification_date": "2025-06-02", "credential": "MD", "enumeration_date": "2007-01-30", "first_name": "JOHN", "last_name": "THOMISON", "last_updated": "2025-06-23", "middle_name": "BROWN", "name_suffix": "III", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1170191550000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1750691313000", "number": "1093852352", "other_names": [], "practiceLocations": [ { "address_1": "4250 BETHEL RD, DEPT OF PATHOLOGY", "address_purpose": "LOCATION", "address_type": "DOM", "city": "OLIVE BRANCH", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "38654", "state": "MS", "telephone_number": "901-516-7182" } ], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "21801", "primary": false, "state": "MS", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "45788", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "PO BOX 405827", "address_purpose": "MAILING", "address_type": "DOM", "city": "ATLANTA", "country_code": "US", "country_name": "United States", "postal_code": "303845800", "state": "GA" }, { "address_1": "80 HUMPHREYS CENTER DR STE 200", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-578-2572", "postal_code": "381202352", "state": "TN", "telephone_number": "901-578-2538" } ], "basic": { "credential": "MD", "enumeration_date": "2007-04-12", "first_name": "ANDRE", "last_name": "THOMPSON", "last_updated": "2016-10-25", "middle_name": "C", "name_prefix": "--", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1176353115000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1477421660000", "number": "1538383765", "other_names": [ { "code": "1", "credential": "MD", "first_name": "ALI", "last_name": "ALI", "prefix": "--", "suffix": "--", "type": "Former Name" } ], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "44591", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "877 JEFFERSON AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-302-2053", "postal_code": "381032807", "state": "TN", "telephone_number": "901-545-7100" }, { "address_1": "PO BOX 660599", "address_purpose": "MAILING", "address_type": "DOM", "city": "DALLAS", "country_code": "US", "country_name": "United States", "postal_code": "752660599", "state": "TX" } ], "basic": { "credential": "MD", "enumeration_date": "2009-07-10", "first_name": "KWAME", "last_name": "TORGBE", "last_updated": "2018-10-16", "middle_name": "EMMANUEL", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1247258234000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "003181858A", "issuer": null, "state": "GA" }, { "code": "05", "desc": "MEDICAID", "identifier": "103i220873", "issuer": null, "state": "MO" }, { "code": "05", "desc": "MEDICAID", "identifier": "1730318718", "issuer": null, "state": "AL" }, { "code": "05", "desc": "MEDICAID", "identifier": "211164001", "issuer": null, "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "Q017545", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1539715362000", "number": "1730318718", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "53541", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "390200000X", "desc": "Student in an Organized Health Care Education/Training Program", "license": null, "primary": false, "state": null, "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1068 CRESTHAVEN RD STE 300", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381190809", "state": "TN", "telephone_number": "901-866-8864" }, { "address_1": "1068 CRESTHAVEN RD STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381190809", "state": "TN", "telephone_number": "901-866-8864" } ], "basic": { "authorized_official_first_name": "COURTNEY", "authorized_official_last_name": "LOVE", "authorized_official_telephone_number": "9018668105", "authorized_official_title_or_position": "Chief Administrative Officer", "certification_date": "2025-01-23", "enumeration_date": "2005-08-17", "last_updated": "2025-01-23", "organization_name": "UT MEDICAL GROUP INC", "organizational_subpart": "NO", "status": "A" }, "created_epoch": "1124304655000", "endpoints": [], "enumeration_type": "NPI-2", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "04721062", "issuer": null, "state": "MS" }, { "code": "05", "desc": "MEDICAID", "identifier": "107355002", "issuer": null, "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "154277", "issuer": null, "state": "AL" }, { "code": "05", "desc": "MEDICAID", "identifier": "1780676650", "issuer": null, "state": "IL" }, { "code": "05", "desc": "MEDICAID", "identifier": "3715279", "issuer": null, "state": "TN" }, { "code": "05", "desc": "MEDICAID", "identifier": "500425103", "issuer": null, "state": "MO" }, { "code": "05", "desc": "MEDICAID", "identifier": "65906117", "issuer": null, "state": "KY" } ], "last_updated_epoch": "1737659121000", "number": "1780676650", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "103TH0004X", "desc": "Psychologist, Health", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "207N00000X", "desc": "Dermatology", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "207Q00000X", "desc": "Family Medicine", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "207R00000X", "desc": "Internal Medicine", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "207V00000X", "desc": "Obstetrics & Gynecology", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "207W00000X", "desc": "Ophthalmology", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "2080N0001X", "desc": "Pediatrics, Neonatal-Perinatal Medicine", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "2084N0400X", "desc": "Psychiatry & Neurology, Neurology", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "2084P0800X", "desc": "Psychiatry & Neurology, Psychiatry", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "2084P0802X", "desc": "Psychiatry & Neurology, Addiction Psychiatry", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "208600000X", "desc": "Surgery", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "2086S0122X", "desc": "Surgery, Plastic and Reconstructive Surgery", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" }, { "code": "261QM1300X", "desc": "Clinic/Center, Multi-Specialty", "license": null, "primary": true, "state": null, "taxonomy_group": "" }, { "code": "363A00000X", "desc": "Physician Assistant", "license": null, "primary": false, "state": null, "taxonomy_group": "193200000X - Multi-Specialty Group" } ] }, { "addresses": [ { "address_1": "930 MADISON AVE STE 500", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381033410", "state": "TN", "telephone_number": "901-448-6300" }, { "address_1": "1068 CRESTHAVEN RD STE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381190809", "state": "TN", "telephone_number": "901-866-8748" } ], "basic": { "authorized_official_first_name": "COURTNEY", "authorized_official_last_name": "LOVE", "authorized_official_telephone_number": "9018668105", "authorized_official_title_or_position": "VP of Organ Effectiveness Admin", "certification_date": "2025-01-23", "enumeration_date": "2023-05-23", "last_updated": "2025-01-23", "organization_name": "UTMG PATHOLOGY, LLC", "organizational_subpart": "YES", "parent_organization_legal_business_name": "UT MEDICAL GROUP, INC.", "status": "A" }, "created_epoch": "1684868420000", "endpoints": [], "enumeration_type": "NPI-2", "identifiers": [], "last_updated_epoch": "1737660438000", "number": "1346932852", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": null, "primary": true, "state": null, "taxonomy_group": "193400000X - Single Specialty Group" }, { "code": "207ZP0105X", "desc": "Pathology, Clinical Pathology/Laboratory Medicine", "license": null, "primary": false, "state": null, "taxonomy_group": "193400000X - Single Specialty Group" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2020-06-02", "credential": "M.D.", "enumeration_date": "2007-04-12", "first_name": "BARRY", "last_name": "WHITE", "last_updated": "2020-06-02", "middle_name": "JAMES", "name_prefix": "Dr.", "name_suffix": "--", "sex": "M", "sole_proprietor": "YES", "status": "A" }, "created_epoch": "1176401371000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1591119801000", "number": "1245454149", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "060336", "primary": false, "state": "GA", "taxonomy_group": "" }, { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "BP10031728", "primary": false, "state": "TX", "taxonomy_group": "" }, { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "MD44945", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" }, { "address_1": "1211 UNION AVE", "address_2": "SUITE 300", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-725-9721", "postal_code": "381046638", "state": "TN", "telephone_number": "901-725-7551" } ], "basic": { "credential": "M.D.", "enumeration_date": "2005-12-09", "first_name": "FRANK", "last_name": "WHITE", "last_updated": "2007-12-27", "middle_name": "L", "name_prefix": "--", "name_suffix": "--", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1134141740000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3041877", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1198775252000", "number": "1255316592", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "006566", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "150 COLLINS ST", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381123814", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "150 COLLINS ST", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381123814", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "enumeration_date": "2005-08-03", "first_name": "SUSAN", "last_name": "WILLIAMS", "last_updated": "2007-07-08", "middle_name": "THERESA", "name_prefix": "Dr.", "name_suffix": "--", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1123093068000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "0121717", "issuer": null, "state": "MS" }, { "code": "05", "desc": "MEDICAID", "identifier": "139353001", "issuer": null, "state": "AR" }, { "code": "05", "desc": "MEDICAID", "identifier": "3827899", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1183947785000", "number": "1891796520", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "MD29006", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "1265 UNION AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-276-5474", "postal_code": "381043415", "state": "TN", "telephone_number": "901-516-7182" }, { "address_1": "PO BOX 603283", "address_purpose": "MAILING", "address_type": "DOM", "city": "CHARLOTTE", "country_code": "US", "country_name": "United States", "fax_number": "678-459-0526", "postal_code": "282603283", "state": "NC", "telephone_number": "866-789-4893" } ], "basic": { "credential": "M.D", "enumeration_date": "2012-07-11", "first_name": "NOUR", "last_name": "YADAK", "last_updated": "2018-09-24", "middle_name": "MOHAMMAD", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1342062951000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1537802010000", "number": "1215292594", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "57458", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3700 WASHINGTON AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "EVANSVILLE", "country_code": "US", "country_name": "United States", "fax_number": "812-471-6650", "postal_code": "477500001", "state": "IN", "telephone_number": "812-485-4347" }, { "address_1": "PO BOX 3186", "address_purpose": "MAILING", "address_type": "DOM", "city": "EVANSVILLE", "country_code": "US", "country_name": "United States", "fax_number": "812-471-6650", "postal_code": "477313186", "state": "IN", "telephone_number": "812-471-1591" } ], "basic": { "certification_date": "2024-08-26", "credential": "MD", "enumeration_date": "2005-09-20", "first_name": "HONGYU", "last_name": "YANG", "last_updated": "2024-08-26", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1127238489000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "200515220", "issuer": null, "state": "IN" } ], "last_updated_epoch": "1724699887000", "number": "1750377305", "other_names": [], "practiceLocations": [ { "address_1": "6000 HOSPITAL DR", "address_purpose": "LOCATION", "address_type": "DOM", "city": "HANNIBAL", "country_code": "US", "country_name": "United States", "fax_number": "573-248-5655", "postal_code": "634016887", "state": "MO", "telephone_number": "573-248-5338" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "taxonomies": [ { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "01060420a", "primary": false, "state": "IN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "2003014719", "primary": false, "state": "MO", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "01060420a", "primary": true, "state": "IN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "3495 HACKS CROSS RD", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" }, { "address_1": "3495 HACKS CROSS RD", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-526-0791", "postal_code": "381258803", "state": "TN", "telephone_number": "901-526-7444" } ], "basic": { "certification_date": "2024-11-22", "credential": "MD, PhD", "enumeration_date": "2006-07-15", "first_name": "NASIR", "last_name": "ZAIDI", "last_updated": "2024-11-22", "middle_name": "HUSSAIN", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1152949859000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1732301060000", "number": "1851317465", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "2001011449", "primary": false, "state": "MO", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "04-29273", "primary": false, "state": "KS", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "51410", "primary": true, "state": "TN", "taxonomy_group": "" }, { "code": "207ZD0900X", "desc": "Pathology, Dermatopathology", "license": "51410", "primary": false, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "50 N DUNLAP ST STE R264", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381032800", "state": "TN", "telephone_number": "901-287-6213" }, { "address_1": "50 N DUNLAP ST STE R264", "address_purpose": "MAILING", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "postal_code": "381032800", "state": "TN", "telephone_number": "901-287-6213" } ], "basic": { "certification_date": "2025-03-29", "credential": "M.D", "enumeration_date": "2007-03-02", "first_name": "JIE", "last_name": "ZHANG", "last_updated": "2025-03-29", "name_prefix": "Dr.", "sex": "F", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1172854341000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [ { "code": "05", "desc": "MEDICAID", "identifier": "3000604", "issuer": null, "state": "TN" } ], "last_updated_epoch": "1743262442000", "number": "1629106281", "other_names": [], "practiceLocations": [], "taxonomies": [ { "code": "207ZH0000X", "desc": "Pathology, Hematology", "license": "41527", "primary": false, "state": "TN", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "41527", "primary": true, "state": "TN", "taxonomy_group": "" } ] }, { "addresses": [ { "address_1": "877 JEFFERSON AVE", "address_purpose": "LOCATION", "address_type": "DOM", "city": "MEMPHIS", "country_code": "US", "country_name": "United States", "fax_number": "901-302-2067", "postal_code": "381032807", "state": "TN", "telephone_number": "901-545-7514" }, { "address_1": "PO BOX 64592", "address_purpose": "MAILING", "address_type": "DOM", "city": "BALTIMORE", "country_code": "US", "country_name": "United States", "fax_number": "410-328-0929", "postal_code": "212644592", "state": "MD", "telephone_number": "410-328-5555" } ], "basic": { "certification_date": "2023-12-13", "credential": "M.D.", "enumeration_date": "2006-07-02", "first_name": "XIANFENG", "last_name": "ZHAO", "last_updated": "2023-12-13", "middle_name": "F", "name_prefix": "Dr.", "sex": "M", "sole_proprietor": "NO", "status": "A" }, "created_epoch": "1151887508000", "endpoints": [], "enumeration_type": "NPI-1", "identifiers": [], "last_updated_epoch": "1702504133000", "number": "1821027640", "other_names": [], "practiceLocations": [ { "address_1": "22 S GREENE ST", "address_2": "NBW73", "address_purpose": "LOCATION", "address_type": "DOM", "city": "BALTIMORE", "country_code": "US", "country_name": "United States", "fax_number": "410-328-0929", "postal_code": "212011544", "state": "MD", "telephone_number": "410-328-5514" } ], "taxonomies": [ { "code": "207ZP0101X", "desc": "Pathology, Anatomic Pathology", "license": "D0063352", "primary": false, "state": "MD", "taxonomy_group": "" }, { "code": "207ZP0102X", "desc": "Pathology, Anatomic Pathology & Clinical Pathology", "license": "68660", "primary": true, "state": "TN", "taxonomy_group": "" } ] } ] }