JACKSON RADIOLOGY ASSOCIATES PA (NPI# 1699700716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699700716 |
| Entity Type | Organization |
| Organization Name | JACKSON RADIOLOGY ASSOCIATES PA |
| Practice Address |
620 Skyline Dr Jackson TN 38301-3901 |
| Mailing Address |
1947 Madison St Ste A Clarksville TN 37043-8062 |
| Practice Telephone | 7315416174 |
| Practice Fax Number | 7314256274 |
| Mailing Telephone | 3166852371 |
| Mailing Fax Number | 9315526663 |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2017-12-26 |
| Authorized Official Name | GREGORY BRUNO (PRESIDENT) |
| Authorized Official Telephone | 7315416174 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085U0001X |
Radiology Specialization: Diagnostic Ultrasound |
Allopathic & Osteopathic Physicians | ||
| N | 2085B0100X |
Radiology Specialization: Body Imaging |
Allopathic & Osteopathic Physicians | ||
| N | 2085N0700X |
Radiology Specialization: Neuroradiology |
Allopathic & Osteopathic Physicians | ||
| N | 2085N0904X |
Radiology Specialization: Nuclear Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2085P0229X |
Radiology Specialization: Pediatric Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0203X |
Radiology Specialization: Therapeutic Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0205X |
Radiology Specialization: Radiological Physics |
Allopathic & Osteopathic Physicians | ||
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | MEDICARE PIN | 315752 | 01 |
| CA | CALIFORNIA MDCR | CG753Z | 01 |
| TN | 3729238 | 05 | |
| NEVADA MEDICARE | CG710B | 01 | |
| HI | PALMETTO HAWAII | CG710C | 01 |
| RAILROAD MEDICARE | DD9799 | 01 |
| Street Address |
620 SKYLINE DR |
| City | JACKSON |
| State | TN |
| Zip Code | 38301-3901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821094608 | Julie A Mcbroom | Nurse Anesthetist, Certified Registered | 620 Skyline Dr, Jackson, TN 38301-3923 | 2005-06-25 |
| 1205440260 | Heather Middleton | Registered Nurse | 620 Skyline Dr, Jackson, TN 38301-3923 | 2020-09-06 |
| 1780297291 | Holly R Jones | Nurse Practitioner | 620 Skyline Dr, Jackson, TN 38301-3923 | 2020-08-25 |
| 1851909972 | Earl Wade Lomax | Student in an Organized Health Care Education/Training Program | 620 Skyline Dr, Jackson, TN 38301-3923 | 2020-07-15 |
| 1356960835 | Gregory Heath Mcneely | Registered Nurse | 620 Skyline Dr, Jackson, TN 38301-3923 | 2020-04-14 |
| 1174157515 | Matthew Lee Luttrell | Nurse Practitioner | 620 Skyline Dr, Jackson, TN 38301-3923 | 2020-02-25 |
| 1528698594 | Heidi Hill | Nurse Practitioner | 620 Skyline Dr, Jackson, TN 38301-3923 | 2020-01-18 |
| 1407406861 | Justin Harrison | Nurse Anesthetist, Certified Registered | 620 Skyline Dr, Jackson, TN 38301-3923 | 2019-09-18 |
| 1770131856 | Shelby Kathryn Berry | Nurse Anesthetist, Certified Registered | 620 Skyline Dr, Jackson, TN 38301-3923 | 2019-08-30 |
| 1891342028 | Jack Harold Fields IIi | Nurse Anesthetist, Certified Registered | 620 Skyline Dr, Jackson, TN 38301-3923 | 2019-08-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124634696 | Lindsey Crowder | Social Worker | 127 Mccowat Street, Jackson, TN 38301 | 2020-09-21 |
| 1366928087 | Primary Care - South Limited | Clinic/Center | 1385 South Highland Ave, Suite B-1, Jackson, TN 38301 | 2018-07-16 |
| 1629592522 | Tlc Home Care Services, LLC | In Home Supportive Care | 39 Old Denmark Rd, Jackson, TN 38301 | 2017-08-01 |
| 1841730421 | Southern Hands Quality Care | In Home Supportive Care | 1298 N. Highland Avenue. Suite 14, Jackson, TN 38301 | 2017-03-02 |
| 1881044477 | Katie Mcmickin | Counselor | 163 Sunnyside Dr, Jackson, TN 38301 | 2016-06-15 |
| 1164815064 | Hailey Archer | Dietitian, Registered | 720 W. Forest Ave., Jackson, TN 38301 | 2015-03-17 |
| 1740673714 | Regina Tignor | Nurse Practitioner | 1410 Us Highway 70 Byp, Jackson, TN 38301 | 2015-03-13 |
| 1194114033 | Woman's Clinic | Obstetrics & Gynecology | 242 Coatsland, Jackson, TN 38301 | 2015-01-15 |
| 1659797702 | Worthy Walker Arrington | Nurse Practitioner | 720 West Forest Avenue, Jackson, TN 38301 | 2014-03-13 |
| 1669717302 | Lift Wellness Inc | General Practice | 101 Jackson Walk Plaza, Jackson, TN 38301 | 2012-12-06 |
| Find all providers in zip 38301 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063890754 | Phil Otis Nelson Jr. | Radiology | 146 Ridge Dr, Jackson, MS 39216-4109 | 2015-05-13 |
| 1891030946 | Cherry Hill Radiology Pllc | Radiology | 401 Redfield Dr, Jackson, TN 38305-8555 | 2012-11-30 |
| 1245414275 | Breathit County Imaging Center | Radiology | 1389 Ky Hwy 15 North, St. John Newmans Medical Plaza, Jackson, KY 41339 | 2007-12-27 |
| 1407933930 | Karen Collette Jensen | Radiology | 14 Adams Road, Jackson, NH 03846 | 2006-11-01 |
| 1770676801 | Gerald O Daniel | Radiology | 708 W Forest Avenue, Jackson, TN 38301 | 2006-10-02 |
| 1497761837 | Arlin George Hatfield IIi | Radiology | 1405 North State Street, Suite 200, Jackson, MS 39202 | 2006-07-31 |
| 1225083942 | Robert Houston Hardin Jr. | Radiology | 2210 Heritage Hill Dr, Jackson, MS 39211-5821 | 2006-05-23 |
| 1881655967 | Jane Warne Brown | Radiology | 91 Stonehaven Cir, Jackson, TN 38305-1945 | 2006-03-29 |
| 1780645028 | Andrew Laurence Rivard | Radiology | 2500 State Street, University of Mississippi Medical Center, Jackson, MS 39216 | 2006-03-28 |
| 1013985134 | John A. Sullivan | Radiology | 7330 Ryegrass Road, Jackson, WY 83001 | 2006-03-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.