Active NPI
William Blake Hubbard, PA
- Physician Assistant
- Tuscaloosa, AL
National Provider Identifier
1245619469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA.1054
- Practice address
- 100 Rice Mine Road Loop Ste 206
Tuscaloosa, AL 35406-2418 - Phone
- (205) 339-0171
- NPI assigned
- May 20, 2015
- Last updated
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA.1054 | AL | Primary |
Addresses
Primary practice location
100 Rice Mine Road Loop Ste 206
Tuscaloosa, AL 35406-2418
Mailing address
100 Rice Mine Road Loop Ste 206
Tuscaloosa, AL 35406-2418
Phone (205) 339-0171
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160517001257 | AL | Order and Referring Only - Physician Assistant | 1254620172 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA.1054 | AL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1245619469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 RICE MINE ROAD LOOP STE 206",
"city": "TUSCALOOSA",
"state": "AL",
"postal_code": "354062418",
"telephone_number": "205-339-0171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 RICE MINE ROAD LOOP STE 206",
"city": "TUSCALOOSA",
"state": "AL",
"postal_code": "354062418",
"telephone_number": "205-339-0171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUBBARD",
"first_name": "WILLIAM",
"middle_name": "BLAKE",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-05-20",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AL",
"license": "PA.1054",
"primary": true
}
],
"identifiers": [],
"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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.