Med 360 Urgent Care Northport LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MED 360 URGENT CARE NORTHPORT LLC

Practice address

3250 McFarland Blvd
Northport, AL 35476-3135

Phone

(205) 487-4535

Fax

(205) 487-8875

NPI assigned

Oct 5, 2022

Last updated

Oct 8, 2024By 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

Dr. Farouk A Raquib, MDNPI 1477511194

Title

Owner/ MD

Phone

(205) 326-3875

Specialties & licenses 1

Addresses

Other identifiers 4

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Farouk Anwarul Raquib, MD

  • Family Medicine Physician
  • Winfield, AL
  • NPI 1477511194
  Medicare reassignment Care Compare group NPD Authorized official
• Kimberly Sprouse, FNP-C

  • Family Nurse Practitioner
  • Columbus, MS
  • NPI 1922549773

  AL

  Medicare reassignment Care Compare group NPD
• Jennifer Caroline Josey, D.C., CRNP

  • Family Nurse Practitioner
  • Winfiled, AL
  • NPI 1669541843
  Medicare reassignment

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

{
    "created_epoch": "1664928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1073238747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3250 MCFARLAND BLVD STE A",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354763135",
            "telephone_number": "205-632-3875",
            "fax_number": "205-462-3056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 MCFARLAND BLVD",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354763135",
            "telephone_number": "205-487-4535",
            "fax_number": "205-487-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED 360 URGENT CARE NORTHPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-05",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "RAQUIB",
        "authorized_official_first_name": "FAROUK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/ MD",
        "authorized_official_telephone_number": "205-326-3875",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1477511194",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "315872",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "322964",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "512-92816",
            "state": "AL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Farouk.raquib@winneuro.direct.medconnect-inc.com",
            "affiliation": "Y",
            "endpointDescription": "direct msg with EMR",
            "affiliationName": "Farouk A. Raquib, M.D., P.C.",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "125 Bob Lawrence Drive",
            "city": "Winfield",
            "state": "AL",
            "country_code": "US",
            "postal_code": "35594",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Latoya McKinstry
• Megan McManus, MS, RDN, LD
• Ben F McMath III, PH.D.
• Kevin Taylor McMurtrie, PHARMD
• Devonna D McNees, PHARMD
• Med-South, Inc.
• Medcenter Primary Care, LLC (MedCenter NorthRiver)
• Medical Vision Associates of Northport
• Megan Watkins Kidd, OD, LLC
• Meharry Physical Therapy, Inc.

• Family Medicine Physician in Northport, AL
• Providers in Northport, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; 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.