Agape Medical Clinic PC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1061751 Issued in AL

Legal business name

AGAPE MEDICAL CLINIC PC

Practice address

1911 Military St S
Hamilton, AL 35570

Phone

(205) 952-9603

Fax

(205) 952-9661

NPI assigned

Mar 29, 2007

Last updated

Nov 10, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dorothy E Stidham, CRNPNPI 1578664652

Title

President

Phone

(205) 952-9603

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 5

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.

• Dorothy Ellen Stidham, CRNP

  • Family Nurse Practitioner
  • Hamilton, AL
  • NPI 1578664652
  Medicare reassignment Care Compare group NPD Authorized official
• Vanessa Ann Ragland, D.O.

  • Family Medicine Physician
  • Haleyville, AL
  • NPI 1417041047
  Medicare reassignment Care Compare group NPD
• Britney B Sullins, CRNP

  • Family Nurse Practitioner
  • Hamilton, AL
  • NPI 1942832951
  Medicare reassignment Care Compare group NPD
• Brenteney Fortune, FNP-C, CRNP

  • Family Nurse Practitioner
  • Fulton, MS
  • NPI 1275357121
  NPD
• Holly Cooper, CRNP

  • Family Nurse Practitioner
  • Guin, AL
  • NPI 1477011179
  NPD (past)

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668038400000",
    "number": "1174643852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2282",
            "city": "HAMILTON",
            "state": "AL",
            "postal_code": "35570",
            "telephone_number": "205-952-9603",
            "fax_number": "205-952-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 MILITARY ST S",
            "city": "HAMILTON",
            "state": "AL",
            "postal_code": "35570",
            "telephone_number": "205-952-9603",
            "fax_number": "205-952-9661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAPE MEDICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A",
        "authorized_official_last_name": "STIDHAM",
        "authorized_official_first_name": "DOROTHY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-952-9603",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1061751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051552982STI",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Hamilton, AL
• Providers in Hamilton, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.