Individual provider Active NPI

Jeffery C Laubenthal, MD

  • Family Medicine Physician
  • Tuscaloosa, AL
National Provider Identifier
1184796211
Registry record updated Feb 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
00021965 Issued in AL
Practice address
100 Rice Mine Road Loop
Suite 206
Tuscaloosa, AL 35406-2414
Phone
(205) 339-0171
Fax
(205) 333-8681
NPI assigned
Nov 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 00021965 AL Primary

Addresses

Primary practice location

100 Rice Mine Road Loop
Suite 206
Tuscaloosa, AL 35406-2414

Mailing address

100 Rice Mine Road Loop
Suite 206
Tuscaloosa, AL 35406-2414
Phone (205) 339-0171

Other identifiers 1

IdentifierTypeStateIssuer
009956980MedicaidAL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20041015000538 AL Practitioner - Family Practice 1658331442 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Alabama School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Alabama Family Practice and Sports Medicine PCGroup PAC ID 1254236755, 7 clinicians

Practice addresses (Care Compare)

100 Rice Mine Rd Loop
Suite 206
Tuscaloosa, AL 35406-2418
Phone (205) 339-0171

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
00021965ALMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Alabama Family Practice & Sports Medicine PC Family Medicine CurrentSince Sep 1, 2001 Accepting new patients

Locations

1325 McFarland Blvd
Ste 206
Northport, AL 35476
Phone (205) 330-4989

100 Rice Mine Road Loop
Ste 206
Tuscaloosa, AL 35406
Phone (205) 339-0171

Interoperability endpoints

  • Direct secure messaging: jeffery.laubenthal@wafpsm.gwaydirect.com

Organizations & group practices 1

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203552000000",
    "number": "1184796211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 RICE MINE ROAD LOOP",
            "address_2": "SUITE 206",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354062414",
            "telephone_number": "205-339-0171",
            "fax_number": "205-333-8681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 RICE MINE ROAD LOOP",
            "address_2": "SUITE 206",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354062414",
            "telephone_number": "205-339-0171",
            "fax_number": "205-333-8681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAUBENTHAL",
        "first_name": "JEFFERY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "00021965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009956980",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuscaloosa, AL

Sources for this page

Verify at the official NPI Registry.