Park Thetford Chittom, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

5342 Issued in AL

Practice address

509 Parkman Ave
Selma, AL 36701-5734

Phone

(334) 874-9064

Fax

(334) 874-2633

NPI assigned

Nov 4, 2005

Last updated

Jan 25, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

University of Mississippi School of Medicine, 1969

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Selma Doctors Clinic PCGroup PAC ID 4183698699, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centerwell Home Health Home health agency, Selma, AL, CCN 017084
• Southerncare New Beacon - Jasper Hospice, Northport, AL, CCN 011506
• Vaughan Regional Medical Center Parkway Campus Hospital, Selma, AL, CCN 010118
• Park Place Nursing home, Selma, AL, CCN 015084

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• bcbs alabama network 01H0
• bcbs alabama network 01C0
• bcbs alabama network 01E0
• bcbs alabama network 01A0
• bcbs alabama network 01B0
• bcbs alabama network 01G0

Interoperability endpoints

• Direct secure messaging: park.chittom@selmadrscpc.direct.medconnect-inc.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Selma Doctors Clinic PC

  • Internal Medicine Physician
  • Selma, AL
  • NPI 1891776050
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Diversicare of Selma, LLC

  dba Park Place

  • Skilled Nursing Facility
  • Selma, AL
  • NPI 1265973457

  Nursing home

  Care Compare affiliation
• Mid-South Home Health, LLC

  dba Centerwell Home Health

  • Home Health Agency
  • Selma, AL
  • NPI 1558392795
  Care Compare affiliation
• New Beacon Healthcare Group, LLC

  dba New Beacon of Jasper

  • Community Based Hospice Care Agency
  • Northport, AL
  • NPI 1376572255
  Care Compare affiliation
• Vaughan Regional Medical Center LLC

  dba Vaughan Regional Medical Center

  • Rural Acute Care Hospital
  • Selma, AL
  • NPI 1871655993
  Care Compare affiliation

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201219200000",
    "number": "1164413308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 PARKMAN AVE",
            "address_2": "P.O. BOX 530",
            "city": "SELMA",
            "state": "AL",
            "postal_code": "367015734",
            "telephone_number": "334-874-9064",
            "fax_number": "334-874-2633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 PARKMAN AVE",
            "city": "SELMA",
            "state": "AL",
            "postal_code": "367015734",
            "telephone_number": "334-874-9064",
            "fax_number": "334-874-2633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHITTOM",
        "first_name": "PARK",
        "middle_name": "THETFORD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-04",
        "last_updated": "2008-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "5342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000003686",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110191475",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Central Alabama Women's Clinic
• Charles L. Lett, M D P C
• Children's Dentistry of Central Alabama, PC
• Demetric Childs-Hicks, CRNP
• Park Thetford Chittom II, M.D.
• Christian Services for Children in Alabama (NBA Christian Services for Children in Alabama)
• City Blocks Wellness Center, Inc
• Daniel Clanton Clower, M.D.
• Jason Douglas Cobb, M.D.
• Jamia Elizabeth Symone Coleman, NP

• Internal Medicine Physician in Selma, AL
• Providers in Selma, AL by specialty
• Internal Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.

Verify at the official NPI Registry.