NPIMap

Organization Active NPI

Sand Mountain Family Practice Center, P. C.

  • Family Medicine Physician
  • Albertville, AL
National Provider Identifier
1255349346
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SAND MOUNTAIN FAMILY PRACTICE CENTER, P. C.
Practice address
5104 US Highway 431
Albertville, AL 35950-0237
Phone
(256) 878-8180
Fax
(256) 891-3693
NPI assigned
Aug 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Dr. Michael Wayne Peters, M.D.NPI 1477501906
Title
President
Phone
(256) 878-8186

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

5104 US Highway 431
Albertville, AL 35950-0237

Mailing address

5104 US Highway 431
Albertville, AL 35950-0237
Phone (256) 878-8180

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060105000782 AL Part B Supplier - Clinic/Group Practice 7517980493 Receives reassigned benefits from 5 practitioners
Practice locations: Albertville, AL

National Provider Directory

National Provider Directory

Member organizations 1

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

Locations

5104 US Highway 431
Albertville, AL 35950
Phone (256) 878-8180

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19522/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1255349346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5104 US HIGHWAY 431",
            "city": "ALBERTVILLE",
            "state": "AL",
            "postal_code": "359500237",
            "telephone_number": "256-878-8180",
            "fax_number": "256-891-3693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5104 US HIGHWAY 431",
            "city": "ALBERTVILLE",
            "state": "AL",
            "postal_code": "359500237",
            "telephone_number": "256-878-8180",
            "fax_number": "256-891-3693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAND MOUNTAIN FAMILY PRACTICE CENTER, P. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "256-878-8186",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albertville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.