NPIMap

Organization Active NPI

Magnolia Commons Pediatrics LLC

  • Pediatric Adolescent Medicine Physician
  • Wetumpka, AL
National Provider Identifier
1013280486
Registry record updated Feb 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
19637 Issued in AL
Legal business name
MAGNOLIA COMMONS PEDIATRICS LLC
Practice address
78 Cambridge CT
Wetumpka, AL 36093-1259
Phone
(334) 567-4311
Fax
(334) 567-4312
NPI assigned
Feb 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2012

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

Authorized official

Name
Michael D Bruce
Title
Ceo
Phone
(334) 567-4311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X 19637 AL Primary

Addresses

Primary practice location

78 Cambridge CT
Wetumpka, AL 36093-1259

Mailing address

78 Cambridge CT
Wetumpka, AL 36093-1259
Phone (334) 567-6915

Other names 1

  • CARLILE PEDIATRICS Doing business as

National Provider Directory

National Provider Directory

Locations

78 Cambridge Ct
Wetumpka, AL 36093
Phone (334) 567-6915

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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
01D2160778Carlile Pediatrics78 Cambridge Court, Wetumpka, AL 36093Certificate of waiverJan 16, 2027

NPI Registry JSON

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

{
    "created_epoch": "1329350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1013280486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 CAMBRIDGE CT",
            "city": "WETUMPKA",
            "state": "AL",
            "postal_code": "360931259",
            "telephone_number": "334-567-6915",
            "fax_number": "334-514-7269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 CAMBRIDGE CT",
            "city": "WETUMPKA",
            "state": "AL",
            "postal_code": "360931259",
            "telephone_number": "334-567-4311",
            "fax_number": "334-567-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA COMMONS PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-16",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "BRUCE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-567-4311"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "AL",
            "license": "19637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CARLILE PEDIATRICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wetumpka, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.