NPIMap

Organization Active NPI

DCH Provider Services, LLC

Doing business as DCH Primary Care Health & Wellness

  • Family Medicine Physician
  • Tuscaloosa, AL
National Provider Identifier
1124711726
Registry record updated May 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DCH PROVIDER SERVICES, LLC
Doing business as
DCH Primary Care Health & Wellness
Practice address
701 University Blvd E Ste 211
Tuscaloosa, AL 35401-7431
Phone
(205) 759-6165
NPI assigned
May 30, 2023
Last updated
May 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2023

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

Authorized official

Name
Daniel Clay Conville
Title
Corp Director, Physician Services
Phone
(205) 759-6165

Specialties & licenses 1

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

Addresses

Primary practice location

701 University Blvd E Ste 211
Tuscaloosa, AL 35401-7431

Mailing address

3901 Greensboro Ave Ste a
Tuscaloosa, AL 35405-3771
Phone (205) 759-6165

Other names 1

  • DCH Primary Care Health & Wellness Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180504001564 AL Part B Supplier - Clinic/Group Practice 6800150517 Receives reassigned benefits from 86 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fayette, AL; Northport, AL; Tuscaloosa, AL

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
DCH Pediatric Hospitalists5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1685404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685404800000",
    "number": "1124711726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 GREENSBORO AVE STE A",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354053771",
            "telephone_number": "205-759-6165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 UNIVERSITY BLVD E STE 211",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354017431",
            "telephone_number": "205-759-6165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DCH PROVIDER SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-30",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A",
        "authorized_official_last_name": "CONVILLE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "CLAY",
        "authorized_official_title_or_position": "CORP DIRECTOR, PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "205-759-6165"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DCH Primary Care Health & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 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.