Customized Medical Needs is a medicare enrolled "Substance Abuse Rehabilitation Facility" provider in Memphis, Tennessee. Their current practice location is
578 Harrell St, Memphis, Tennessee. You can reach out to their office (for appointments etc.) via phone at
(901) 907-0640.
Customized Medical Needs is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Customized Medical Needs
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1124361688.
Healthcare Provider's Profile
| Full Name | Customized Medical Needs |
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| Type | Facility |
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| Speciality | Substance Abuse Rehabilitation Facility |
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| Location | 578 Harrell St, Memphis, Tennessee |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1124361688
- Provider Enumeration Date: 04/03/2013
- Last Update Date: 09/29/2025
Medicare PECOS Information:
- PECOS PAC ID: 8921249517
- Enrollment ID: O20130724000352
Medical Identifiers
Medical identifiers for Customized Medical Needs such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1124361688 | NPI | - | NPPES |
| 1531379 | Medicaid | TN | |
| 103G700897 | Other | TN | MEDICARE (PTAN) |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 235Z00000X | Speech-language Pathologist | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | 305 (Tennessee) | Secondary |
| 133V00000X | Dietitian, Registered | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Secondary |
| 224Z00000X | Occupational Therapy Assistant | (* (Not Available)) | Secondary |
| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| 225200000X | Physical Therapy Assistant | (* (Not Available)) | Secondary |
| 163W00000X | Registered Nurse | (* (Not Available)) | Secondary |
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| 225X00000X | Occupational Therapist | (* (Not Available)) | Secondary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Secondary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Customized Medical Needs acts as a billing entity for following providers:
| Provider Name | Dwight Anthony Dishmon |
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| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
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| Provider Identifiers | NPI Number: 1316904048
PECOS PAC ID: 9931165941
Enrollment ID: I20041201001010 |
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| Provider Name | Darl Vilbro Bell |
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| Provider Type | Practitioner - Internal Medicine |
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| Provider Identifiers | NPI Number: 1275538977
PECOS PAC ID: 5294718474
Enrollment ID: I20051222000714 |
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| Provider Name | Keevia Porter |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1770742066
PECOS PAC ID: 7517039399
Enrollment ID: I20080710000798 |
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| Provider Name | Kendrick Joyce |
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| Provider Type | Practitioner - Anesthesiology |
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| Provider Identifiers | NPI Number: 1801949847
PECOS PAC ID: 2466518956
Enrollment ID: I20090309000259 |
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| Provider Name | Theresa Lynette Woodard |
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| Provider Type | Practitioner - Internal Medicine |
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| Provider Identifiers | NPI Number: 1124045638
PECOS PAC ID: 6002814241
Enrollment ID: I20120131000410 |
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| Provider Name | Brenita M Seay |
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| Provider Type | Practitioner - Mental Health Counselor |
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| Provider Identifiers | NPI Number: 1639707144
PECOS PAC ID: 7618419789
Enrollment ID: I20240604002358 |
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| Provider Name | Darin Dantzler |
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| Provider Type | Practitioner - Mental Health Counselor |
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| Provider Identifiers | NPI Number: 1215375316
PECOS PAC ID: 6103361282
Enrollment ID: I20240712002359 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Customized Medical Needs is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Customized Medical Needs
578 Harrell St,
Memphis, TN 38112-2932
Ph: (901) 907-0640 | Customized Medical Needs
578 Harrell St,
Memphis, TN 38112-2932
Ph: (901) 907-0640 |
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