Northside Medical, Inc.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

NORTHSIDE MEDICAL, INC.

Practice address

211 Greenhill Blvd NW
Fort Payne, AL 35967-3755

Phone

(256) 845-9355

NPI assigned

Nov 2, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Robert W. Theakston, M.D.NPI 1255374492

Title

President

Phone

(256) 845-9355

Specialties & licenses 1

Addresses

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Northside Onsite Medical Services, Inc.

  • Family Medicine Physician
  • Fort Payne, AL
  • NPI 1386056216
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert W Theakston, M.D.

  • General Practice Physician
  • Fort Payne, AL
  • NPI 1255374492
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1225584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225584000000",
    "number": "1205089372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 680047",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359681601",
            "telephone_number": "256-845-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 GREENHILL BLVD NW",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359673755",
            "telephone_number": "256-845-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-02",
        "last_updated": "2008-11-02",
        "status": "A",
        "authorized_official_last_name": "THEAKSTON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "256-845-9355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Dalsgaard Nielsen, MD
• Nna of Alabama, Inc. (RCG Fort Payne)
• Heather Noojin, CRNP
• Northeast Alabama Health Services, Inc. (Northeast Alabama Health Services Inc - Fort Payne)
• Northland Hearing Centers, Inc. (The Hearing Center of Fort Payne)
• Northside Onsite Medical Services, Inc.
• Casey Nowlin
• Steve L Nunley, CRNA
• Lauren Obenlander
• Glynn Whiddon Odom, CRNA

• Primary Care Clinic/Center in Fort Payne, AL
• Providers in Fort Payne, AL by specialty
• Primary Care Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2008; 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.