NPIMap

Organization Active NPI

Island Medical Alabama LLC

  • Emergency Medicine Physician
  • Cullman, AL
National Provider Identifier
1104097666
Registry record updated Feb 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
ISLAND MEDICAL ALABAMA LLC
Practice address
1912 Al Highway 157
Cullman, AL 35058-0609
Phone
(844) 474-4019
NPI assigned
Mar 12, 2008
Last updated
Feb 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2023

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

Authorized official

Name
Melissa Reese
Title
Provider Enrollment Officer
Phone
(855) 687-0618

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X AL Primary

Addresses

Primary practice location

1912 Al Highway 157
Cullman, AL 35058-0609

Mailing address

4535 Dressler Rd NW
Canton, OH 44718-2545
Phone (330) 994-4409

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080515000492 AL Part B Supplier - Clinic/Group Practice 3072682103 Receives reassigned benefits from 136 practitioners
Practice locations: Cullman, AL; Hartselle, AL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 153

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 153

NPI Registry JSON

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

{
    "created_epoch": "1205280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677196800000",
    "number": "1104097666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4535 DRESSLER RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182545",
            "telephone_number": "330-994-4409",
            "fax_number": "330-492-8489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 AL HIGHWAY 157",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350580609",
            "telephone_number": "844-474-4019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND MEDICAL ALABAMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-12",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A",
        "authorized_official_last_name": "REESE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT OFFICER",
        "authorized_official_telephone_number": "855-687-0618"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cullman, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.