Spectracare Health Systems, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

SPECTRACARE HEALTH SYSTEMS, INC.

Practice address

134 Prevatt Rd
Dothan, AL 36301-5427

Phone

(334) 794-0731

Fax

(334) 671-9199

NPI assigned

Apr 7, 2006

Last updated

Nov 28, 2012By 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

Ms. Melissa Kirkland

Title

Executive Director

Phone

(334) 712-2720

Specialties & licenses 3

Addresses

Other identifiers 16

Other names 1

• Wiregrass Mental Health Board, Inc. Former legal business name

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Locations

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.

• Spectracare Integrated Services LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dothan, AL
  • NPI 1205385176
  NPPES parent name

Practitioners 29

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.

• Kelli Nicole Beaty, MS, LPC, ADC

  • Professional Counselor
  • Dothan, AL
  • NPI 1437933348
  Medicare reassignment Care Compare group NPD
• Tabitha England, LPC

  • Professional Counselor
  • Dothan, AL
  • NPI 1861932063
  Medicare reassignment Care Compare group NPD
• Lisa Barry Fuller

  • Professional Counselor
  • Dothan, AL
  • NPI 1407407372
  Medicare reassignment Care Compare group NPD
• Nicole Anne Godwin, MS, LPC, ADC, QSAP I

  • Professional Counselor
  • Dothan, AL
  • NPI 1396585824
  Medicare reassignment Care Compare group NPD
• Hannah Jo Jakelsky, CRNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Dothan, AL
  • NPI 1588451637
  Medicare reassignment Care Compare group NPD
• Fernando Lopez, M.D.

  • Psychiatry Physician
  • Dothan, AL
  • NPI 1659391951
  Medicare reassignment Care Compare group NPD
• Stephanie Michelle Potter, LPC

  • Professional Counselor
  • Enterprise, AL
  • NPI 1013670462
  Medicare reassignment Care Compare group NPD
• Lisa Turner Rambo, LPC

  • Professional Counselor
  • Dothan, AL
  • NPI 1578084885
  Medicare reassignment Care Compare group NPD
• Bobby Stephen Sanders Jr., MD, MPH

  • Family Medicine Physician
  • Dothan, AL
  • NPI 1174790299
  Medicare reassignment Care Compare group NPD
• Kelly Skipper, LPC

  • Counselor
  • Dothan, AL
  • NPI 1316730757
  Medicare reassignment Care Compare group NPD
• Kimberly Smith

  • Professional Counselor
  • Dothan, AL
  • NPI 1699235440
  Medicare reassignment Care Compare group NPD
• Kenna Miranda Walters, LPC

  • Counselor
  • Dothan, AL
  • NPI 1689346934
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1215990734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1245",
            "address_2": "2694 SOUTH PARK AVE.",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363021245",
            "telephone_number": "334-712-2720",
            "fax_number": "334-712-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 PREVATT RD",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363015427",
            "telephone_number": "334-794-0731",
            "fax_number": "334-671-9199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRACARE HEALTH SYSTEMS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-07",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "KIRKLAND",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "334-712-2720",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331000069",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331000467",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "059726100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330034010",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL INSURANCE",
            "identifier": "51003550",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008412000",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331600592",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "591600003",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008301620",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330000010",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33000010",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331000067",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51043903",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "590000010",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "591500003",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331600587",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wiregrass Mental Health Board, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Lauren Spathias, DMD
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• Anthony Roland Spedale Jr., MD
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• Mental Health Clinic/Center (Including Community Mental Health Center) in Dothan, AL
• Providers in Dothan, AL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; 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.