NPIMap

Organization Active NPI

Capshaw Family Care

  • Family Medicine Physician
  • Harvest, AL
National Provider Identifier
1104260256
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CAPSHAW FAMILY CARE
Practice address
27669 Capshaw Rd Ste A2
Harvest, AL 35749-6212
Phone
(256) 216-1996
Fax
(256) 216-1940
NPI assigned
Apr 19, 2013
Last updated
Jan 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Authorized official

Name
Sebrina B Holt
Title
Executive Director
Phone
(256) 216-9648

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

27669 Capshaw Rd Ste A2
Harvest, AL 35749-6212

Mailing address

PO Box 999
Athens, AL 35612-0999
Phone (256) 216-1996

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130612000150 AL Part B Supplier - Clinic/Group Practice 2163661703 Receives reassigned benefits from 7 practitioners
Practice locations: Harvest, AL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1366329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1104260256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 999",
            "city": "ATHENS",
            "state": "AL",
            "postal_code": "356120999",
            "telephone_number": "256-216-1996",
            "fax_number": "256-216-1940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27669 CAPSHAW RD STE A2",
            "city": "HARVEST",
            "state": "AL",
            "postal_code": "357496212",
            "telephone_number": "256-216-1996",
            "fax_number": "256-216-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPSHAW FAMILY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-19",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "HOLT",
        "authorized_official_first_name": "SEBRINA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "256-216-9648"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harvest, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; 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.