NPIMap

Organization Active NPI

Whatley Health Services Inc

Doing business as Maude L. Whatley Health Centers

  • Federally Qualified Health Center (FQHC)
  • Tuscaloosa, AL
National Provider Identifier
1063422756
Registry record updated May 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WHATLEY HEALTH SERVICES INC
Doing business as
Maude L. Whatley Health Centers
Practice address
2731 MLK Jr Blvd
Tuscaloosa, AL 35401-5235
Phone
(205) 349-3250
Fax
(205) 345-3993
NPI assigned
Aug 8, 2006
Last updated
May 17, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
WHATLEY HEALTH SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 17, 2022

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

Authorized official

Name
David Ellis Gay
Title
Ceo
Phone
(205) 758-6647

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

2731 MLK Jr Blvd
Tuscaloosa, AL 35401-5235

Mailing address

2731 MLK Jr Blvd
Tuscaloosa, AL 35401-5235
Phone (205) 349-3250

Other identifiers 1

IdentifierTypeStateIssuer
630000005MedicaidAL

Other names 1

  • MAUDE L. WHATLEY HEALTH CENTERS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040206000846 AL Part B Supplier - Clinic/Group Practice 8224921705 Receives reassigned benefits from 230 practitioners
6 other NPIs on this enrollment
Practice locations: Tuscaloosa, AL; Vernon, AL; Sipsey, AL; Livingston, AL; Greensboro, AL; Gordo, AL; Eutaw, AL; Carrollton, AL…
O20101116000178 AL Part A Provider - Federally Qualified Health Center (FQHC) 8224921705 Practice locations: Tuscaloosa, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063422756. Details of each certification follow.

Federally qualified health center certification: CCN 011810

Legal name
WHATLEY HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 11, 1997 in AL
Enrollment address
2731 Martin Luther King Blvd
Tuscaloosa, AL 35401-5235

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Part of
Okaman Health Center

Locations

800 Hall St
Greensboro, AL 36744
Phone (334) 624-0871

3532 Greensboro Ave
Tuscaloosa, AL 35401
Phone (205) 614-6177

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Maxie Thomas Individual Corporate Director May 27, 1997
David Gay Individual Corporate DirectorChief Executive Officer Nov 1, 2018 100%
W-2 Managing EmployeeChief Executive Officer Nov 1, 2018 100%
Audrey J Ellis Individual Corporate Director Dec 1, 2007
James Morton Individual Corporate Director Jan 1, 2008
Reginald Zane Motley Individual Corporate Director May 24, 2022
Marvin Wiggins Individual Corporate Director Aug 24, 2021
Charlotte Carter Individual Corporate Director Mar 25, 1997
Kanita Sturdivant Individual Corporate Director Aug 24, 2021

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 257

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 257

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652745600000",
    "number": "1063422756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2731 MLK JR BLVD",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354015235",
            "telephone_number": "205-349-3250",
            "fax_number": "205-345-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2731 MLK JR BLVD",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354015235",
            "telephone_number": "205-349-3250",
            "fax_number": "205-345-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHATLEY HEALTH SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHATLEY HEALTH SERVICES, INC",
        "enumeration_date": "2006-08-08",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A",
        "authorized_official_last_name": "GAY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ELLIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "205-758-6647"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630000005",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAUDE L. WHATLEY HEALTH CENTERS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MAUDE L. WHATLEY HEALTH CENTERS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tuscaloosa, AL

Sources for this page

Verify at the official NPI Registry.