NPIMap

Organization Active NPI

Tuskaloosa Internal Medicine LLC

  • Internal Medicine Physician
  • Tuscaloosa, AL
National Provider Identifier
1235221847
Registry record updated Mar 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
TUSKALOOSA INTERNAL MEDICINE LLC
Practice address
1100 Ruby Tyler Pkwy
Tuscaloosa, AL 35404-2959
Phone
(205) 759-2582
Fax
(205) 759-2985
NPI assigned
Sep 29, 2006
Last updated
Mar 1, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2013

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

Authorized official

Name
Ross B Vaughn, M.D.NPI 1184715021
Title
Partner
Phone
(205) 759-2582

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
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X AL Primary

Addresses

Primary practice location

1100 Ruby Tyler Pkwy
Tuscaloosa, AL 35404-2959

Mailing address

1100 Ruby Tyler Pkwy
Tuscaloosa, AL 35404-2959
Phone (205) 759-2582

Other identifiers 2

IdentifierTypeStateIssuer
528601940MedicaidAL
CC0235OtherALRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051121000551 AL Part B Supplier - Clinic/Group Practice 2264451137 Receives reassigned benefits from 9 practitioners
Practice locations: Tuscaloosa, 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
01D0301734Tuskaloosa Internal Medicine LLC1100 Ruby Tyler Parkway, Tuscaloosa, AL 35404AccreditationDec 22, 2027

National Provider Directory

National Provider Directory

Locations

1100 Ruby Tyler Pkwy
Tuscaloosa, AL 35404
Phone (205) 759-2582

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362096000000",
    "number": "1235221847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 RUBY TYLER PKWY",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354042959",
            "telephone_number": "205-759-2582",
            "fax_number": "205-759-2985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 RUBY TYLER PKWY",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354042959",
            "telephone_number": "205-759-2582",
            "fax_number": "205-759-2985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUSKALOOSA INTERNAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2013-03-01",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "ROSS",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "205-759-2582",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528601940",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC0235",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2013; 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.