Primary Care Pediatrics and Family Medicine, P.C
Organization Active NPI Pediatrics Physician · Harvest, AL
NPI 1083078596 · NPPES record last updated Sep 2, 2016
Key facts
- NPI
- 1083078596
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- PRIMARY CARE PEDIATRICS AND FAMILY MEDICINE, P.C
- Practice address
- 29869 Capshaw Road
Harvest, AL 35749 - Phone
- (256) 262-1040
- Fax
- (256) 325-2180
- NPI assigned
- Apr 11, 2016
- Organization subpart
- No
Authorized official
- Name
- Dr. Shraddha Shrestha, M.D
- Title
- Ceo
- Phone
- (256) 425-3668
Practitioners 3
-
Binod Bista, MD
-
Shraddha Shrestha, M.D.
-
Amelia Mauldin, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D2113426 | Primary Care Pediatrics and Family Medicine PC | Certificate of waiver | May 22, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160923002152 | AL | Part B Supplier - Clinic/Group Practice | 2668769308 |
Receives reassigned benefits from 2 practitioners Practice locations: Harvest, AL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
29869 Capshaw Road
Harvest, AL 35749
Mailing address
PO Box 269
Capshaw, AL 35742-0269
Phone (256) 262-1040
Other providers in Harvest, AL
- Steven Petty
- Devon Marie Ploshay
- Melony Lashawn Pointer
- Arin Keli Pratt
- Premier Urgent Care Inc.
- Publix Alabama LLC
- Chloe Ellen Raum
- Renew Homecare
- Alicia E Roe
- Carlie Collazo Rogers
All providers in Harvest, AL · Pediatrics Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.