NPIMap

Opelika Pediatrics & Family Clinic PC

Organization Active NPI Clinic/Center · Opelika, AL

NPI 1306240502 · NPPES record last updated Jun 9, 2017

Key facts

NPI
1306240502
Entity type
Organization (NPI type 2)
Primary specialty
Clinic/Center 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
Organization subpart
No

Authorized official

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

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Owners & managing parties with NPI records 1

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

  • Ritu Chandra, MD Pediatrics Physician · Phenix City, AL · NPI 1003890849
    CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST

Practitioners 17

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2085831Opelika Pediatrics & Family Clinic PC
5809 Hwy 280E, Opelika, AL 36804		Certificate of waiverOct 22, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in AL

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
Corporation · Proprietary
Incorporated
Aug 14, 2014 in AL
Enrollment address
5809 Hwy 280E
Opelika, AL 36804-8515

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 Interest
President		 Aug 14, 2014 100%
Rajiv Srivastava
Individual 		W-2 Managing Employee
Administrator		 May 1, 2015

Medicare enrollment records

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

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207L00000X AL
Adult Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207QA0505X AL
Geriatric Medicine (Family Medicine) Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207QG0300X AL
Pediatrics Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208000000X AL
General Practice Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208D00000X AL
Clinic/Center 261Q00000X Yes

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

  • Preferred Medical Group Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 9, 2017.

{
    "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": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "AL",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AL",
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "AL",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AL",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "AL",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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

All providers in Opelika, AL · Clinic/Center in Alabama

Sources for this page

Verify at the official NPI Registry.