NPIMap

Organization Active NPI

Fort Payne Pediatrics LLC

  • Rural Health Clinic/Center
  • Fort Payne, AL
National Provider Identifier
1033477393
Registry record updated Mar 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
01-8910 Issued in AL
Legal business name
FORT PAYNE PEDIATRICS LLC
Practice address
1906 Glenn Blvd SW Ste 100a
Fort Payne, AL 35968-3546
Phone
(256) 997-5900
NPI assigned
Apr 24, 2012
Last updated
Mar 31, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2014

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

Authorized official

Name
Peter Strogov, MDNPI 1295964682
Title
Physician/Owner
Phone
(256) 997-5900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X 30426 AL
Rural Health Clinic/Center 261QR1300X 01-8910 AL Primary
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X 1-075895 AL
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X 1-087445 AL

Addresses

Primary practice location

1906 Glenn Blvd SW Ste 100a
Fort Payne, AL 35968-3546

Mailing address

1906 Glenn Blvd SW Ste 100a
Fort Payne, AL 35968-3546
Phone (256) 997-5900

Other identifiers 1

IdentifierTypeStateIssuer
139385MedicaidAL

Other names 1

  • Ft Payne Pediatrics,LLC Other name

National Provider Directory

National Provider Directory

Locations

23800 John T Reid Pkwy
Scottsboro, AL 35768
Phone (256) 997-5900

350 Springville Sta
Springville, AL 35146
Phone (205) 773-2075

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1335225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396224000000",
    "number": "1033477393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 GLENN BLVD SW STE 100A",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359683546",
            "telephone_number": "256-997-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 GLENN BLVD SW STE 100A",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359683546",
            "telephone_number": "256-997-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT PAYNE PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-24",
        "last_updated": "2014-03-31",
        "status": "A",
        "authorized_official_last_name": "STROGOV",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "256-997-5900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "30426",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AL",
            "license": "01-8910",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-075895",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-087445",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139385",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ft Payne Pediatrics,LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Payne, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.