NPIMap

Organization Active NPI

Opelika Pediatrics & Family Clinic PC

  • Clinic/Center
  • Opelika, AL
National Provider Identifier
1306240502
Registry record updated Jun 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
OPELIKA PEDIATRICS & FAMILY CLINIC PC
Practice address
5809 Hwy 280E
Opelika, AL 36804
Phone
(334) 705-6966
Fax
(334) 664-0466
NPI assigned
Oct 16, 2014
Last updated
Jun 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2017

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

Authorized official

Name
Dr. Ritu Chandra, M.DNPI 1003890849
Title
President
Phone
(334) 664-0463

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Anesthesiology Physician 207L00000X AL
Adult Medicine Physician 207QA0505X AL
Geriatric Medicine (Family Medicine) Physician 207QG0300X AL
Pediatrics Physician 208000000X AL
General Practice Physician 208D00000X AL

Addresses

Primary practice location

5809 Hwy 280E
Opelika, AL 36804

Mailing address

3700 S Railroad St Ste a
Phenix City, AL 36867-2994
Phone (334) 664-0463

Other names 1

  • Preferred Medical Group Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150611003458 AL Part A Provider - Rural Health Clinic 5890006183 Practice locations: Opelika, AL
O20200323001378 AL Part B Supplier - Clinic/Group Practice 5890006183 Receives reassigned benefits from 16 practitioners
Practice locations: Opelika, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306240502. Details of each certification follow.

Rural health clinic certification: CCN 018920

Legal name
OPELIKA PEDIATRICS & FAMILY CLINIC PC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 17, 2015
Last certification
Jul 26, 2023
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Aug 14, 2014 in AL
Enrollment address
5809 Hwy 280E
Opelika, AL 36804-8515

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
01D2085831Opelika Pediatrics & Family Clinic PC5809 Hwy 280E, Opelika, AL 36804Certificate of waiverOct 22, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Ritu Chandra Individual 5% Or Greater Direct Ownership InterestPresident Aug 14, 2014 100%
Rajiv Srivastava Individual W-2 Managing EmployeeAdministrator May 1, 2015

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1413417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496966400000",
    "number": "1306240502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 S RAILROAD ST STE A",
            "city": "PHENIX CITY",
            "state": "AL",
            "postal_code": "368672994",
            "telephone_number": "334-664-0463",
            "fax_number": "334-664-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5809 HWY 280E",
            "city": "OPELIKA",
            "state": "AL",
            "postal_code": "36804",
            "telephone_number": "334-705-6966",
            "fax_number": "334-664-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPELIKA PEDIATRICS & FAMILY CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-16",
        "last_updated": "2017-06-09",
        "status": "A",
        "authorized_official_last_name": "CHANDRA",
        "authorized_official_first_name": "RITU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "334-664-0463",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AL",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AL",
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "AL",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Preferred Medical Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Preferred Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Opelika, AL

Sources for this page

Verify at the official NPI Registry.