Basic Information
Provider Information | |||||||||
NPI: | 1285672592 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HESSLER | ||||||||
FirstName: | RICHARD | ||||||||
MiddleName: | B | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5301 VIRGINIA WAY | ||||||||
Address2: | SUITE 300 | ||||||||
City: | BRENTWOOD | ||||||||
State: | TN | ||||||||
PostalCode: | 370277541 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6152214474 | ||||||||
FaxNumber: | 6152343774 | ||||||||
Practice Location | |||||||||
Address1: | 5301 VIRGINIA WAY | ||||||||
Address2: | SUITE 300 | ||||||||
City: | BRENTWOOD | ||||||||
State: | TN | ||||||||
PostalCode: | 370277541 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6152214474 | ||||||||
FaxNumber: | 6152343774 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/02/2006 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 40994 | TN | Y |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
ID | Type | State | Issuer | Description | 37821 | 01 | TN | TLC TENNCARE | OTHER | 100050770 | 01 | TN | PHP TENNCARE | OTHER | 3338711 | 05 | TN |   | MEDICAID | 5904442 | 05 | NC |   | MEDICAID | 000815405B | 05 | GA |   | MEDICAID | 10057940 | 01 | GA | AMERIGROUP | OTHER | 4129020 | 01 | TN | BLUE SHIELD | OTHER | 64121130 | 05 | KY |   | MEDICAID | 000815405C | 05 | GA |   | MEDICAID | 009938126 | 05 | AL |   | MEDICAID | 335786 | 01 | GA | WELLCARE | OTHER |