Marc Alan Hultquist, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

3042 Issued in AL

Practice address

12205 County Line Rd Ste C
Madison, AL 35758-7720

Phone

(256) 258-8319

Fax

(256) 489-4070

NPI assigned

Oct 20, 2006

Last updated

Feb 26, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: marc.hultquist.1@30916.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Reagan's Clinic, LLC

  • Developmental - Behavioral Pediatrics Physician
  • Madison, AL
  • NPI 1558123190

  Multi-Specialty

  Medicare reassignment NPD Authorized official
• Alabama Developmental and Diagnostic Clinic LLC

  • Medical Specialty Clinic/Center
  • Madison, AL
  • NPI 1346946308
  NPD Authorized official

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1063595593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12205 COUNTY LINE RD STE C",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357587720",
            "telephone_number": "256-258-8319",
            "fax_number": "256-489-4070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12205 COUNTY LINE RD STE C",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357587720",
            "telephone_number": "256-258-8319",
            "fax_number": "256-489-4070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4301 Mow-Way Rd",
            "address_2": "Reynolds Army Hospital (ATTN: MCUA-QC, Ms. Prescott)",
            "address_purpose": "LOCATION",
            "city": "Fort Sill",
            "state": "OK",
            "postal_code": "735036300",
            "country_code": "US",
            "telephone_number": "580-458-2134",
            "fax_number": "580-458-2314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HULTQUIST",
        "first_name": "MARC",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "3331",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "3042",
            "primary": true
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "AL",
            "license": "3042",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karli Howard, LMSW
• Hsinvestsf (ChiroSource Madison)
• Charlotte Karen Hubbard, RPH
• Jayda Hughes
• Philandrya D Hughley, M.S.ED, ALC
• Derek Hunt
• Matthew J Hunt, MD
• Hunter H. Snyder, O.D., P.C.
• Huntsville Hospital Madison Internal Medicine
• Huntsville Hospital Surgical Associates of Madison

• Pediatrics Physician in Madison, AL
• Providers in Madison, AL by specialty
• Pediatrics Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.