NPIMap

Organization Active NPI

Custom Healthcare, LLC

Doing business as Phoenix Rehab & Mobility

  • Customized Equipment (DME)
  • Phenix City, AL
National Provider Identifier
1083195663
Registry record updated Mar 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
License
1511 Issued in AL
Legal business name
CUSTOM HEALTHCARE, LLC
Doing business as
Phoenix Rehab & Mobility
Practice address
902 12TH St Ste B
Phenix City, AL 36867-5827
Phone
(334) 560-5777
Fax
(423) 648-9366
NPI assigned
Aug 22, 2018
Last updated
Mar 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2019

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

Authorized official

Name
James C Rogers
Title
Ceo
Phone
(423) 697-0057

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1511 AL
Customized Equipment (DME) 332BC3200X 1511 AL Primary
Prosthetic/Orthotic Supplier 335E00000X NU

Addresses

Primary practice location

902 12TH St Ste B
Phenix City, AL 36867-5827

Mailing address

3700 Brainerd Rd
Chattanooga, TN 37411-3603
Phone (423) 697-0057

Other names 1

  • Phoenix Rehab & Mobility Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200312000393 AL DME Supplier - Medical Supply CompanyDME Supplier - Medical Supply Company With Orthotic Personnel 7911028410 Practice locations: Phenix City, AL

Other NPIs with the same Medicare PAC ID 3

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

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Custom Healthcare, LLC902 12TH St, Phenix City, AL 36867-5827(334) 560-5777 Commodes, Urinals, Bedpans|Hospital Beds (Electric)|Hospital Beds (Manual)|Support Surfaces: Pressure Reducing Beds/Mats/Pads|Canes and/or Crutches|Patient Lifts|Power Operated Vehicles (Scooters)|Seat Lift Mechanisms|Walkers|Wheelchairs (Standard Manual)|Wheelchairs (Standard Manual Related Access… Does not accept assignmentParticipating since Jan 1, 1999

National Provider Directory

National Provider Directory
Tax ID family
Custom Healthcare12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

902 12th St
Ste B
Phenix City, AL 36867
Phone (334) 560-5777

2150 N Ocoee St
Ste 2
Cleveland, TN 37311
Phone (423) 559-0013

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1534896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552003200000",
    "number": "1083195663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 BRAINERD RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374113603",
            "telephone_number": "423-697-0057",
            "fax_number": "423-648-9366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 12TH ST STE B",
            "city": "PHENIX CITY",
            "state": "AL",
            "postal_code": "368675827",
            "telephone_number": "334-560-5777",
            "fax_number": "423-648-9366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-22",
        "last_updated": "2019-03-08",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "423-697-0057"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AL",
            "license": "1511",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "AL",
            "license": "1511",
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Rehab & Mobility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phenix City, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2019; 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.