NPIMap

State of Alabama Dept of Finance

Organization Active NPI Psychiatric Hospital · Tuscaloosa, AL

NPI 1033213624 · NPPES record last updated May 9, 2024

Key facts

NPI
1033213624
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatric Hospital 283Q00000X
Legal business name
STATE OF ALABAMA DEPT OF FINANCE
Practice address
115 Harper Court
Tuscaloosa, AL 35401
Phone
(205) 366-3010
Fax
(205) 366-3012
NPI assigned
Sep 12, 2006
Organization subpart
Yes
Parent organization (as reported)
STATE OF ALABAMA DEPARTMENT OF FINANCE

Authorized official

Name
Melissa D Shaw
Title
Accounting Assistant II
Phone
(205) 366-3038

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 5

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

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 44

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

View all 44

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 35

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

View all 35

Medicare Care Compare: Hospital

Listed as
Mary S Harper Geriatric Psychiatry Center CCN 014012
Type
Psychiatric
Ownership
Government - State
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0999847Mary S Harper Geriatric Psychiatry Ctr
115 Harper Court, Tuscaloosa, AL 35401		Certificate of waiverMay 23, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in AL

Hospital certification: CCN 014012

Legal name
STATE OF ALABAMA DEPT OF MENTAL HEALTH & MENTAL RETARDATION
Doing business as
MARY STARKE HARPER GERIATRIC PSYCHIATRY CENTER
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 18, 1996
Last certification
Dec 9, 2009
Beds
96
Ownership / control type
State
Organization structure
Other · Non-profit
Incorporated
Jul 18, 1996 in AL
Enrollment address
115 Harper CT
Tuscaloosa, AL 35401-7454
Other Hospital Practice Location
Hospital subgroups
Psychiatric, Psychiatric unit

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Donnell Amerson
Individual 		Corporate Officer
Fiscal Manager I		 Nov 1, 2023
W-2 Managing Employee
Fiscal Manager I		 Nov 1, 2023
Operational/Managerial Control
Fiscal Manager I		 Nov 1, 2023
Sonja Rawls
Individual 		Corporate Director
Facility Director		 Jul 17, 2023
W-2 Managing Employee
Facility Director		 Jul 17, 2023
Operational/Managerial Control
Facility Director		 Jul 17, 2023
State of Alabama Dept of Mental Health & Mental Retardation
Organization · Tuscaloosa, AL
Non-profit 		5% Or Greater Direct Ownership Interest Jul 18, 1996 100%
Operational/Managerial Control Jul 18, 1996 100%

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Bryce Hospital
Tuscaloosa, AL · CCN 014007		 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2012
Jan 1, 2012

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031205000194 AL Part B Supplier - Clinic/Group Practice 5698684090 Receives reassigned benefits from 32 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tuscaloosa, AL; Mount Vernon, AL; Montgomery, AL; Decatur, AL
O20101025000635 AL Part a Provider - Hospital 5698684090 Practice locations: Tuscaloosa, AL

National Provider Directory

Tax ID family
Samual Gaskins MD (45 organizations share this tax ID)
Part of
Samual Gaskins MD

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X AL Yes

Addresses

Primary practice location

115 Harper Court
Tuscaloosa, AL 35401

Mailing address

PO Box 21231
Tuscaloosa, AL 35402
Phone (205) 366-3010

Other identifiers

IdentifierTypeStateIssuer
011659OtherBC CH
012803OtherBC
012803OtherALBLUE CROSS BLUE SHIELD
GER0001HMedicaidAL

Other names

  • Mary Starke Harper Geriatric Psychiatry Center Doing business as

Other providers in Tuscaloosa, AL

All providers in Tuscaloosa, AL · Psychiatric Hospital in Alabama

Sources for this page

Verify at the official NPI Registry.