NPIMap

Organization Active NPI

Clinical Urology Associates, P.C.

  • Urology Physician
  • Albertville, AL
National Provider Identifier
1053025593
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
CLINICAL UROLOGY ASSOCIATES, P.C.
Practice address
9524 US Hwy 431
Albertville, AL 35950-3595
Phone
(256) 492-4040
Fax
(256) 492-4017
NPI assigned
Jan 10, 2023
Last updated
Nov 17, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CLINICAL UROLOGY ASSOCIATES, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

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

Authorized official

Name
Kourtney Mayo
Title
Credentialing
Phone
(256) 613-0322

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

9524 US Hwy 431
Albertville, AL 35950-3595

Mailing address

713 Goodyear Ave
Gadsden, AL 35903-1156
Phone (256) 492-4040

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040820000950 AL Part B Supplier - Clinic/Group Practice 0749254241 Receives reassigned benefits from 16 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pell City, AL; Oneonta, AL; Jacksonville, AL; Fort Payne, AL; Gadsden, AL; Albertville, AL

Other NPIs on the same Medicare enrollment 5

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

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
01D2277570Clinical Urology Associates PC9524 US Hwy 431, Albertville, AL 35950AccreditationMar 25, 2028

National Provider Directory

National Provider Directory
Tax ID family
Clinical Urology Associates8 organizations share this tax ID, including this one
Part of
Clinical Urology Associates

Other organizations with this tax ID 7

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

Ownership & related parties

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.

NPI Registry JSON

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

{
    "created_epoch": "1673308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700179200000",
    "number": "1053025593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 GOODYEAR AVE",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359031156",
            "telephone_number": "256-492-4040",
            "fax_number": "256-492-4017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9524 US HWY 431",
            "city": "ALBERTVILLE",
            "state": "AL",
            "postal_code": "359503595",
            "telephone_number": "256-492-4040",
            "fax_number": "256-492-4017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL UROLOGY ASSOCIATES, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLINICAL UROLOGY ASSOCIATES, P.C.",
        "enumeration_date": "2023-01-10",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A",
        "authorized_official_last_name": "MAYO",
        "authorized_official_first_name": "KOURTNEY",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "256-613-0322"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albertville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; 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.