Active NPI
Medical Center Plus LLC
- General Practice Physician
- Auburn, AL
National Provider Identifier
1104459411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- Legal business name
- MEDICAL CENTER PLUS LLC
- Practice address
- 1685 E University Dr Ste E
Auburn, AL 36830-5217 - Phone
- (334) 501-8867
- NPI assigned
- Feb 14, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Edward Peacock
- Title
- Owner
- Phone
- (334) 501-8867
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | Primary |
Addresses
Primary practice location
1685 E University Dr Ste E
Auburn, AL 36830-5217
Mailing address
1685 E University Dr Ste E
Auburn, AL 36830-5217
Phone (334) 501-8867
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201105000874 | AL | Part B Supplier - Clinic/Group Practice | 7911317755 |
Receives reassigned benefits from 8 practitioners Practice locations: Auburn, AL; Montgomery, AL |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D2312197 | Medical Center Plus LLC | Certificate of waiver | Oct 6, 2026 |
National Provider Directory
National Provider DirectoryLocations
4209 Carmichael Rd
Montgomery, AL 36106
Phone (334) 356-1020
Practitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581638400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1684713600000",
"number": "1104459411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1685 E UNIVERSITY DR STE E",
"city": "AUBURN",
"state": "AL",
"postal_code": "368305217",
"telephone_number": "334-501-8867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1685 E UNIVERSITY DR STE E",
"city": "AUBURN",
"state": "AL",
"postal_code": "368305217",
"telephone_number": "334-501-8867"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDICAL CENTER PLUS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-02-14",
"last_updated": "2023-05-22",
"certification_date": "2023-05-22",
"status": "A",
"authorized_official_last_name": "PEACOCK",
"authorized_official_first_name": "EDWARD",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "334-501-8867"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "General Practice",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; 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.