NPIMap

Organization Active NPI

Alabama Providence Healthcare Services

  • Family Medicine Physician
  • Robertsdale, AL
National Provider Identifier
1174952261
Registry record updated Sep 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ALABAMA PROVIDENCE HEALTHCARE SERVICES
Practice address
18317 US Hwy 90
Robertsdale, AL 36567
Phone
(251) 947-2000
Fax
(251) 947-5399
NPI assigned
Nov 8, 2013
Last updated
Sep 28, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
ALABAMA PROVIDENCE HEALTHCARE SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2015

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

Authorized official

Name
Mr. Todd S. Kennedy
Title
President
Phone
(251) 633-1660

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU

Addresses

Primary practice location

18317 US Hwy 90
Robertsdale, AL 36567

Mailing address

PO Box 850489
Mobile, AL 36685-0489
Phone (251) 342-3949

Other names 1

  • Providence Medical Group Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140127000341 AL Part B Supplier - Clinic/Group Practice 9638308430 Receives reassigned benefits from 110 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mobile, AL; Semmes, AL; Saraland, AL; Robertsdale, AL; Gulf Shores, AL; Fairhope, AL; Citronelle, AL

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Al Prov Hlthcr SRVS27 organizations share this tax ID, including this one
Part of
Al Prov Hlthcr SRVS

Other organizations with this tax ID 26

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

View all 26

Locations

610 Providence Park Dr E
Ste 102
Mobile, AL 36695
Phone (251) 378-3900

18 Rambo Dr
Saraland, AL 36571
Phone (251) 675-2029

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1383868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443398400000",
    "number": "1174952261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850489",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366850489",
            "telephone_number": "251-342-3949",
            "fax_number": "251-631-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18317 US HWY 90",
            "city": "ROBERTSDALE",
            "state": "AL",
            "postal_code": "36567",
            "telephone_number": "251-947-2000",
            "fax_number": "251-947-5399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALABAMA PROVIDENCE HEALTHCARE SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALABAMA PROVIDENCE HEALTHCARE SERVICES",
        "enumeration_date": "2013-11-08",
        "last_updated": "2015-09-28",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "251-633-1660",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Robertsdale, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; 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.