NPIMap

Organization Active NPI

Fayette Medical Center

Doing business as Fayette Medical Center LTC

  • Skilled Nursing Facility
  • Fayette, AL
National Provider Identifier
1245226430
Registry record updated Jul 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
12539 Issued in AL
Legal business name
FAYETTE MEDICAL CENTER
Doing business as
Fayette Medical Center LTC
Practice address
1653 Temple Ave N
Fayette, AL 35555-1314
Phone
(205) 932-1112
Fax
(205) 932-1260
NPI assigned
Sep 22, 2005
Last updated
Jul 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2026

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

Authorized official

Name
David W Herman
Title
VP Finance
Phone
(205) 759-7297

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 12539 AL Primary

Addresses

Primary practice location

1653 Temple Ave N
Fayette, AL 35555-1314

Mailing address

1653 Temple Ave N
Fayette, AL 35555-1314
Phone (205) 932-1112

Other names 1

  • Fayette Medical Center LTC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090810000159 AL Part A Provider - Skilled Nursing Facility 9234035346 Practice locations: Fayette, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245226430. Details of each certification follow.

Skilled nursing facility certification: CCN 015154

Legal name
FAYETTE MEDICAL CENTER
Doing business as
FAYETTE MEDICAL CENTER LTC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1977
Last certification
May 6, 2021
Beds
122
Ownership / control type
County
Organization structure
CorporationNon-profit
Incorporated
Sep 21, 1958 in AL
Enrollment address
1653 Temple N Ave
Fayette, AL 35555-1314
Nursing home name
FAYETTE MEDICAL CENTER LONG TERM CARE UNIT

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Fayette Medical Center Long Term Care UnitCCN 015154 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Government - County
Certified
Apr 1, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
122107.8 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
John Henry Ploussard MD5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Brian S Claytor Individual Corporate OfficerBoard Member Jan 1, 2019
Alex D Dobbins Individual W-2 Managing EmployeeCredentialing Manager Jan 1, 2024
Adp of the SNF Jan 15, 2025
David Gay Individual Corporate OfficerBoard Member Jan 1, 2021
Joseph Colquitt Individual Corporate OfficerBoard Member Jan 1, 1992
David Hudson Individual Corporate OfficerBoard Member Jan 1, 2019
Lewis Standeffer Individual Corporate Director Jun 10, 2009
Rodney G Clark Individual W-2 Managing EmployeeAd; Aug 19, 2024
Adp of the SNF Jan 15, 2025
The DCH Healthcare Authority Organization, Tuscaloosa, AL Non-profit Operational/Managerial Control Aug 16, 1984 100%
Joe M Bedwell Individual W-2 Managing EmployeeDirector of Revenue Cycle Jan 1, 2024
Adp of the SNF Jan 15, 2025
James Harrison Individual Corporate OfficerBoard Member Jan 1, 2008

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Fayette Medical Center HomecareFayette, AL, CCN 017088 Home health agency 5% Or Greater Direct Ownership Interest (33%) Nov 1, 2008

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 12

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.

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785110400000",
    "number": "1245226430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1653 TEMPLE AVE N",
            "city": "FAYETTE",
            "state": "AL",
            "postal_code": "355551314",
            "telephone_number": "205-932-1112",
            "fax_number": "205-932-1260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1653 TEMPLE AVE N",
            "city": "FAYETTE",
            "state": "AL",
            "postal_code": "355551314",
            "telephone_number": "205-932-1112",
            "fax_number": "205-932-1260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A",
        "authorized_official_last_name": "HERMAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "205-759-7297"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AL",
            "license": "12539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fayette Medical Center LTC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fayette Medical Center LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayette, AL

Sources for this page

Verify at the official NPI Registry.