NPIMap

Organization Active NPI

Dale Medical Center

  • Family Medicine Physician
  • Ozark, AL
National Provider Identifier
1003264136
Registry record updated Apr 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DALE MEDICAL CENTER
Practice address
633 South Union Ave
Ozark, AL 36360
Phone
(334) 774-7572
Fax
(334) 774-6237
NPI assigned
May 31, 2016
Last updated
Apr 11, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
DALE MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2018

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

Authorized official

Name
Mr. Vernon L. Johnson
Title
Ceo
Phone
(334) 774-2601

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

633 South Union Ave
Ozark, AL 36360

Mailing address

PO Box 863
Ozark, AL 36361-0863
Phone (334) 443-1211

Other names 1

  • South Union Family Medicine Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031107000202 AL Part B Supplier - Clinic/Group Practice 3476466327 Receives reassigned benefits from 47 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ozark, AL

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0953785South Union Family Medicine633 S Union Ave, Ozark, AL 36360Certificate of waiverNov 9, 2026

National Provider Directory

National Provider Directory
Tax ID family
Dale Medical Center DME13 organizations share this tax ID, including this one
Part of
Dale Medical Center DME

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/dale-309b724a

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523404800000",
    "number": "1003264136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 863",
            "city": "OZARK",
            "state": "AL",
            "postal_code": "363610863",
            "telephone_number": "334-443-1211",
            "fax_number": "334-443-0131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 SOUTH UNION AVE",
            "city": "OZARK",
            "state": "AL",
            "postal_code": "36360",
            "telephone_number": "334-774-7572",
            "fax_number": "334-774-6237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALE MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DALE MEDICAL CENTER",
        "enumeration_date": "2016-05-31",
        "last_updated": "2018-04-11",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "VERNON",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-774-2601",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Union Family Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ozark, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.