NPIMap

Organization Active NPI

Bayside Orthopedic & Rehabilitation Center PC

Doing business as Bayside Orthopaedic, Sports Medicine & Rehabilitation Center

  • Orthopaedic Surgery Physician
  • Fairhope, AL
National Provider Identifier
1215014097
Registry record updated Apr 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
BAYSIDE ORTHOPEDIC & REHABILITATION CENTER PC
Doing business as
Bayside Orthopaedic, Sports Medicine & Rehabilitation Center
Practice address
341 Greeno Rd N
Fairhope, AL 36532-2979
Phone
(251) 928-2401
Fax
(251) 928-5099
NPI assigned
Nov 1, 2006
Last updated
Apr 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2019

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

Authorized official

Name
Rachel L Ellis
Title
Office Manager
Phone
(251) 928-2401

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X Primary
Physical Medicine & Rehabilitation Physician 208100000X

Addresses

Primary practice location

341 Greeno Rd N
Fairhope, AL 36532-2979

Mailing address

PO Box 1186
Fairhope, AL 36533-1186
Phone (251) 928-2401

Other identifiers 1

IdentifierTypeStateIssuer
528700580MedicaidAL

Other names 1

  • Bayside Orthopaedic, Sports Medicine & Rehabilitation Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040709000846 AL Part B Supplier - Clinic/Group Practice 3779561410 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
Practice locations: Brewton, AL; Evergreen, AL; Fairhope, AL; Foley, AL; Gulf Shores, AL

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

341 Greeno Rd N
Fairhope, AL 36532
Phone (251) 210-1320

1622 N McKenzie St
Foley, AL 36535
Phone (251) 928-9954

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555977600000",
    "number": "1215014097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1186",
            "city": "FAIRHOPE",
            "state": "AL",
            "postal_code": "365331186",
            "telephone_number": "251-928-2401",
            "fax_number": "251-928-5099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341 GREENO RD N",
            "city": "FAIRHOPE",
            "state": "AL",
            "postal_code": "365322979",
            "telephone_number": "251-928-2401",
            "fax_number": "251-928-5099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSIDE ORTHOPEDIC & REHABILITATION CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2019-04-23",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "251-928-2401"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528700580",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bayside Orthopaedic, Sports Medicine & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bayside Orthopaedic, Sports Medicine & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairhope, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; 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.