NPIMap

Organization Active NPI

Pediatric Associates of Alexander City PC

  • Pediatrics Physician
  • Alexander City, AL
National Provider Identifier
1144284084
Registry record updated Sep 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC ASSOCIATES OF ALEXANDER CITY PC
Practice address
1962 Cherokee Rd
Alexander City, AL 35010-3437
Phone
(256) 234-5021
Fax
(256) 234-5640
NPI assigned
Apr 17, 2006
Last updated
Sep 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2019

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

Authorized official

Name
Eric Owen Tyler, M.D.NPI 1881658706
Title
President/Ceo
Phone
(256) 234-5021

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

1962 Cherokee Rd
Alexander City, AL 35010-3437

Mailing address

PO Box 1269
Alexander City, AL 35011-1269
Phone (256) 234-5021

Other identifiers 1

IdentifierTypeStateIssuer
528501050MedicaidAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190914000184 AL Part A Provider - Rural Health Clinic 9638168891 Practice locations: Alexander City, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144284084. Details of each certification follow.

Rural health clinic certification: CCN 018945

Legal name
PEDIATRIC ASSOCIATES OF ALEXANDER CITY, P.C.
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 28, 2020
Last certification
Aug 6, 2020
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
May 9, 1985 in AL
Enrollment address
1962 Cherokee Rd
Alexander City, AL 35010-3437

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0299885Pediatric Associates-Alexander City1962 Cherokee Road, Alexander City, AL 35010Provider-performed microscopyDec 6, 2027

National Provider Directory

National Provider Directory

Locations

1962 Cherokee Rd
Alexander City, AL 35010
Phone (256) 234-5021

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Eric Tyler Individual 5% Or Greater Direct Ownership InterestPresident Jul 1, 2001 100%
Corporate OfficerPresident Jul 1, 2001 100%
W-2 Managing EmployeePresident Jul 1, 2001

Practitioners & affiliated clinicians

Practitioners 8

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": "1145232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569369600000",
    "number": "1144284084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1269",
            "city": "ALEXANDER CITY",
            "state": "AL",
            "postal_code": "350111269",
            "telephone_number": "256-234-5021",
            "fax_number": "256-234-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1962 CHEROKEE RD",
            "city": "ALEXANDER CITY",
            "state": "AL",
            "postal_code": "350103437",
            "telephone_number": "256-234-5021",
            "fax_number": "256-234-5640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF ALEXANDER CITY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-17",
        "last_updated": "2019-09-25",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "OWEN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "256-234-5021",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528501050",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexander City, AL

Sources for this page

Verify at the official NPI Registry.