NPIMap

Organization Active NPI

Rural Health Medical Program, Inc

Doing business as Pine Apple Health Center

  • Federally Qualified Health Center (FQHC)
  • Pine Apple, AL
National Provider Identifier
1295804391
Registry record updated Dec 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RURAL HEALTH MEDICAL PROGRAM, INC
Doing business as
Pine Apple Health Center
Practice address
867 County Road 59
Pine Apple, AL 36768-3525
Phone
(251) 746-2197
Fax
(251) 746-2467
NPI assigned
Nov 6, 2006
Last updated
Dec 21, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
RURAL HEALTH MEDICAL PROGRAM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 21, 2010

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

Authorized official

Name
Ms. Patricia Gibson
Title
Ceo
Phone
(334) 874-7428

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X AL Primary

Addresses

Primary practice location

867 County Road 59
Pine Apple, AL 36768-3525

Mailing address

P O Box 2213
228 Selma Avenue
Selma, AL 36702-2213
Phone (334) 874-7428

Other identifiers 2

IdentifierTypeStateIssuer
011836OtherALMEDICARE ID - TYPE UNSPECIFIED
630000008MedicaidAL

Other names 1

  • Pine Apple Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040506001178 AL Part B Supplier - Clinic/Group Practice 0143219196 Receives reassigned benefits from 42 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Demopolis, AL; Marion, AL; Monroeville, AL; Pine Apple, AL; Selma, AL; Thomaston, AL; Uniontown, AL; Vredenburgh, AL…
O20101117001649 AL Part A Provider - Federally Qualified Health Center (FQHC) 0143219196 Practice locations: Pine Apple, AL
O20200407001242 AL MDPP Supplier - in-Person MDPP Supplier 0143219196 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Camden, AL; Demopolis, AL; Marion, AL; Monroeville, AL; Pine Apple, AL; Selma, AL; Thomaston, AL; Uniontown, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295804391. Details of each certification follow.

Federally qualified health center certification: CCN 011836

Legal name
RURAL HEALTH MEDICAL PROGRAM, INC.
Doing business as
PINE APPLE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 30, 1978 in AL
Enrollment address
867 County Road 59
Pine Apple, AL 36768-3525

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Rural HLTH Medical Prog10 organizations share this tax ID, including this one
Part of
Rural HLTH Medical Prog

Other organizations with this tax ID 9

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

Locations

1310 Washington St
Marion, AL 36756
Phone (334) 683-2073

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Rural Health Medical Program, Inc. Organization, Selma, AL Non-profit Operational/Managerial Control Sep 17, 2010
Thomas Moore Individual Corporate Director Sep 17, 2010
Sherman Norfleet Individual Corporate Director Sep 17, 2010
Keshee Danee Smith Individual Corporate DirectorCeo Mar 7, 2016
W-2 Managing EmployeeCeo Mar 7, 2016
Cynthia Ross Individual Corporate Director Sep 17, 2010
John Gragg Individual Corporate Director Sep 17, 2010
Carolyn Turner Individual Corporate Officer Jan 5, 2014
Clifford Spencer Individual Corporate Director Sep 17, 2010
Kennard Randolph Individual Corporate Officer Oct 20, 2014

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
Uniontown Health ServicesUniontown, AL, CCN 011837 Federally qualified health center Operational/Managerial Control Jul 18, 2011

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 1

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

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292889600000",
    "number": "1295804391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 2213",
            "address_2": "228 SELMA AVENUE",
            "city": "SELMA",
            "state": "AL",
            "postal_code": "367022213",
            "telephone_number": "334-874-7428",
            "fax_number": "334-874-7435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "867 COUNTY ROAD 59",
            "city": "PINE APPLE",
            "state": "AL",
            "postal_code": "367683525",
            "telephone_number": "251-746-2197",
            "fax_number": "251-746-2467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH MEDICAL PROGRAM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RURAL HEALTH MEDICAL PROGRAM, INC.",
        "enumeration_date": "2006-11-06",
        "last_updated": "2010-12-21",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-874-7428",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID - TYPE UNSPECIFIED",
            "identifier": "011836",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630000008",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Apple Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pine Apple, AL

Sources for this page

Verify at the official NPI Registry.