NPIMap

Organization Active NPI

Doctors Med Care of Fort Payne, P.C.

  • Family Medicine Physician
  • Fort Payne, AL
National Provider Identifier
1225065022
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DOCTORS MED CARE OF FORT PAYNE, P.C.
Practice address
1040 Glenn Blvd SW
Fort Payne, AL 35967-8413
Phone
(256) 845-6900
Fax
(256) 845-6905
NPI assigned
Jun 27, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Pranav K Mishra, MDNPI 1609800531
Title
President
Phone
(256) 845-6900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1040 Glenn Blvd SW
Fort Payne, AL 35967-8413

Mailing address

1040 Glenn Blvd SW
Fort Payne, AL 35967-8413
Phone (256) 845-6900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060213000725 AL Part B Supplier - Clinic/Group Practice 6002821030 Receives reassigned benefits from 14 practitioners
Practice locations: Ft Payne, AL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D1047618Doctors Med Care of Fort Payne1040 Glenn Blvd SW, Fort Payne, AL 35967ComplianceJun 5, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225065022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 GLENN BLVD SW",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359678413",
            "telephone_number": "256-845-6900",
            "fax_number": "256-845-6905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 GLENN BLVD SW",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359678413",
            "telephone_number": "256-845-6900",
            "fax_number": "256-845-6905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOCTORS MED CARE OF FORT PAYNE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MISHRA",
        "authorized_official_first_name": "PRANAV",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "256-845-6900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Payne, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.