Southlake Orthopaedics Sports Medicine & Spine Center PC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE & SPINE CENTER PC

Doing business as

Southlake Orthopaedics

Practice address

4517 Southlake Pkwy
Birmingham, AL 35244-3280

Phone

(205) 985-4111

Fax

(205) 985-4326

NPI assigned

May 5, 2006

Last updated

Feb 10, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Frances BlumNPI 1518915016

Title

President

Phone

(205) 985-4111

Specialties & licenses 15

Addresses

Other identifiers 2

Other names 1

• Southlake Orthopaedics Doing business as

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Locations

Practitioners 41

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.

• Michael Francis Blum, M.D.

  • Orthopaedic Surgery Physician
  • Birmingham, AL
  • NPI 1518915016

  Specialist

  Medicare reassignment NPD Authorized official
• Nelson D Agee

  • Emergency Medical Services (Emergency Medicine) Physician
  • Bessemer, AL
  • NPI 1467090506

  Foot and Ankle Surgery

  Medicare reassignment NPD
• Lauren Lane Bannon, PA-C

  • Physician Assistant
  • Hoover, AL
  • NPI 1770727497
  Medicare reassignment NPD
• George Robert Booker, MD

  • Orthopaedic Surgery Physician
  • Birmingham, AL
  • NPI 1760692834
  Medicare reassignment NPD
• Eleanor Compton Burke, PA-C

  • Physician Assistant
  • Birmingham, AL
  • NPI 1902544984
  Medicare reassignment NPD
• Anna McClure Casteix, PA-C

  • Physician Assistant
  • Hoover, AL
  • NPI 1689347742
  Medicare reassignment NPD
• Sydney Blair Cork, PA-C

  • Physician Assistant
  • Hoover, AL
  • NPI 1750862637
  Medicare reassignment NPD
• William Smith Craig IV, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Birmingham, AL
  • NPI 1821047259
  Medicare reassignment NPD
• Cathy M Dollar, OT

  • Occupational Therapist
  • Hoover, AL
  • NPI 1861599516
  Medicare reassignment NPD
• Rachel Ragland Elkins, PA-C

  • Physician Assistant
  • Hoover, AL
  • NPI 1619446754
  Medicare reassignment NPD
• Michael Todd Ellerbusch, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Birmingham, AL
  • NPI 1437107984

  Specialist

  Medicare reassignment NPD
• Rachel M Goodwin, PA-C

  • Physician Assistant
  • Birmingham, AL
  • NPI 1700345469
  Medicare reassignment NPD

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1043268402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4517 SOUTHLAKE PKWY",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352443280",
            "telephone_number": "205-985-4111",
            "fax_number": "205-985-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4517 SOUTHLAKE PKWY",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352443280",
            "telephone_number": "205-985-4111",
            "fax_number": "205-985-4326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4524 Southlake Pkwy Ste 26",
            "address_purpose": "LOCATION",
            "city": "Hoover",
            "state": "AL",
            "postal_code": "352443272",
            "country_code": "US",
            "telephone_number": "205-329-7566",
            "fax_number": "888-435-9974",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3686 Grandview Pkwy Ste 430",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "352433404",
            "country_code": "US",
            "telephone_number": "205-605-8180",
            "fax_number": "205-972-8785",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE & SPINE CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "BLUM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "FRANCES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-985-4111"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AL",
            "license": "9307",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225000000X",
            "taxonomy_group": "",
            "desc": "Orthotic Fitter",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2471M1202X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Magnetic Resonance Imaging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "224L00000X",
            "taxonomy_group": "",
            "desc": "Pedorthist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529802230",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "G715",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southlake Orthopaedics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southlake Orthopaedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Orthopaedic Surgery Physician in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Orthopaedic Surgery Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.