NPIMap

Organization Active NPI

Northeast Alabama Health Services, Inc.

Doing business as Northeast Alabama Health Services Inc - Fyffe

  • Federally Qualified Health Center (FQHC)
  • Fyffe, AL
National Provider Identifier
1104973353
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST ALABAMA HEALTH SERVICES, INC.
Doing business as
Northeast Alabama Health Services Inc - Fyffe
Practice address
34617 Al Highway 75
Fyffe, AL 35971-3488
Phone
(256) 623-5242
Fax
(256) 623-5243
NPI assigned
Jan 3, 2007
Last updated
May 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHEAST ALABAMA HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 28, 2024

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

Authorized official

Name
James P Allen Jr.
Title
Ceo
Phone
(256) 259-5313

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

34617 Al Highway 75
Fyffe, AL 35971-3488

Mailing address

34617 Al Highway 75
Fyffe, AL 35971-3488
Phone (256) 623-5242

Other identifiers 3

IdentifierTypeStateIssuer
630008003MedicaidAL
012340OtherALBLUE CROSS BLUE SHIELD
I990OtherALSTATE MEDICARE

Other names 1

  • NORTHEAST ALABAMA HEALTH SERVICES INC - FYFFE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030124000009 AL Part A Provider - Federally Qualified Health Center (FQHC) 4082522883 Practice locations: Fyffe, AL
O20040120000485 AL Part B Supplier - Clinic/Group Practice 4082522883 Receives reassigned benefits from 17 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bryant, AL; Fort Payne, AL; Fyffe, AL; Scottsboro, AL; Section, AL; Woodville, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104973353. Details of each certification follow.

Federally qualified health center certification: CCN 011920

Legal name
NORTHEAST ALABAMA HEALTH SERVICES, INC.
Doing business as
FYFFE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 14, 2003
Last certification
Feb 14, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 28, 1978 in AL
Enrollment address
34617 Al Highway 75
Fyffe, AL 35971-3488

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Sand MTN Primary HLT Ctr6 organizations share this tax ID, including this one
Part of
Sand MTN Primary HLT Ctr

Other organizations with this tax ID 5

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

Locations

29810 AL Highway 71
Bryant, AL 35958
Phone (256) 597-4114

3840 Gault Ave N
Fort Payne, AL 35967
Phone (256) 844-4975

309 Taylor St
Scottsboro, AL 35768
Phone (256) 259-5313

13624 County Road 8
Woodville, AL 35776
Phone (256) 776-5615

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jannette D Haley Individual Corporate DirectorBoard Member Aug 23, 2022
Sylvia Nell Martin Individual Corporate DirectorBoard Member Oct 27, 1998
Charles W Murphree Individual Corporate DirectorBoard Member Jan 24, 2003
Leshia Wilhelm Individual Corporate OfficerCorporate Compliance Officer/DO Mar 10, 2021
W-2 Managing EmployeeDirector of Oper/Corp Compliance of Mar 1, 2013
Tiffany Graben Individual Corporate DirectorBoard Member Jul 28, 2020
Melissa Campbell Individual Corporate DirectorBoard Member Aug 22, 2006
Keshia L Gardner Individual Corporate DirectorBoard Member Jan 26, 2016
Madel R Brown Individual Corporate DirectorBoard Member May 17, 2016
Amanda L Foshee Individual W-2 Managing EmployeeMedical Director/Physician Jun 2, 2023
Paul B Jones Individual Corporate DirectorBoard Member Mar 26, 2019
Angela R Saint Individual Corporate OfficerChief Financial Officer Jan 16, 2015
W-2 Managing Employee Mar 1, 2013
Gayla Bass Individual Corporate DirectorBoard Member Jun 1, 2014
James P Allen Individual W-2 Managing EmployeeChief Executive Officer Apr 29, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 11

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": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1104973353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34617 AL HIGHWAY 75",
            "city": "FYFFE",
            "state": "AL",
            "postal_code": "359713488",
            "telephone_number": "256-623-5242",
            "fax_number": "256-623-5243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34617 AL HIGHWAY 75",
            "city": "FYFFE",
            "state": "AL",
            "postal_code": "359713488",
            "telephone_number": "256-623-5242",
            "fax_number": "256-623-5243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ALABAMA HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST ALABAMA HEALTH SERVICES, INC.",
        "enumeration_date": "2007-01-03",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "256-259-5313",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630008003",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "012340",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICARE",
            "identifier": "I990",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHEAST ALABAMA HEALTH SERVICES INC - FYFFE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fyffe, AL

Sources for this page

Verify at the official NPI Registry.