NPIMap

Organization Active NPI

Whatley Health Services, Inc

Doing business as Vernon Health Center

  • Federally Qualified Health Center (FQHC)
  • Vernon, AL
National Provider Identifier
1114101383
Registry record updated May 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WHATLEY HEALTH SERVICES, INC
Doing business as
Vernon Health Center
Practice address
230 Hospital Dr
Vernon, AL 35592-5251
Phone
(205) 695-0450
Fax
(205) 695-0451
NPI assigned
Dec 24, 2007
Last updated
May 17, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
WHATLEY HEALTH SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 17, 2022

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

Authorized official

Name
Mr. David E Gay Jr.
Title
Ceo
Phone
(205) 758-6647

Specialties & licenses 1

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

Addresses

Primary practice location

230 Hospital Dr
Vernon, AL 35592-5251

Mailing address

2731 MLK Jr Blvd
Tuscaloosa, AL 35401-5235
Phone (205) 349-3250

Other identifiers 1

IdentifierTypeStateIssuer
630011005MedicaidAL

Other names 1

  • VERNON HEALTH CENTER Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040206000846 AL Part B Supplier - Clinic/Group Practice 8224921705 Receives reassigned benefits from 230 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tuscaloosa, AL; Vernon, AL; Sipsey, AL; Livingston, AL; Greensboro, AL; Gordo, AL; Eutaw, AL; Carrollton, AL…
O20080204000172 AL Part A Provider - Federally Qualified Health Center (FQHC) 8224921705 Practice locations: Vernon, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114101383. Details of each certification follow.

Federally qualified health center certification: CCN 011948

Legal name
WHATLEY HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 14, 2008
Last certification
Mar 14, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 11, 1997 in AL
Enrollment address
141 2ND Ave NW
Vernon, AL 35592-5765

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Part of
Whatley Health Services Inc

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Jerry Palmer Individual Corporate Director Dec 16, 2014
Maxie Thomas Individual Corporate Director May 27, 1997
David Gay Individual Corporate OfficerChief Executive Officer Nov 1, 2018
W-2 Managing EmployeeChief Executive Officer Nov 1, 2018
Audrey J Ellis Individual Corporate Director Dec 1, 2007
James Morton Individual Corporate Director Jan 1, 2008
Charlotte Carter Individual Corporate Director Mar 25, 1997

NPI Registry JSON

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

{
    "created_epoch": "1198454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652745600000",
    "number": "1114101383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2731 MLK JR BLVD",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354015235",
            "telephone_number": "205-349-3250",
            "fax_number": "205-345-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 HOSPITAL DR",
            "city": "VERNON",
            "state": "AL",
            "postal_code": "355925251",
            "telephone_number": "205-695-0450",
            "fax_number": "205-695-0451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHATLEY HEALTH SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHATLEY HEALTH SERVICES, INC",
        "enumeration_date": "2007-12-24",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A",
        "authorized_official_last_name": "GAY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "205-758-6647",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630011005",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VERNON HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VERNON HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vernon, AL

Sources for this page

Verify at the official NPI Registry.