NPIMap

Organization Active NPI

SLCM LLC

Doing business as NorthRiver Primary Care Associates

  • Family Medicine Physician
  • Northport, AL
National Provider Identifier
1336474964
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SLCM LLC
Doing business as
NorthRiver Primary Care Associates
Practice address
4310 Watermelon Rd
Northport, AL 35473-5166
Phone
(205) 330-5266
Fax
(205) 330-9915
NPI assigned
Oct 15, 2009
Last updated
Mar 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Authorized official

Name
Nicole Jones
Title
Authorized Official
Phone
(205) 710-6129

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

4310 Watermelon Rd
Northport, AL 35473-5166

Mailing address

4310 Watermelon Rd
Northport, AL 35473-5166
Phone (205) 330-5266

Other identifiers 2

IdentifierTypeStateIssuer
1336474964MedicaidAL
DP9610OtherALMEDICARE RAILROAD

Other names 1

  • NorthRiver Primary Care Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100108000359 AL Part B Supplier - Clinic/Group Practice 9830230119 Receives reassigned benefits from 9 practitioners
Practice locations: Northport, AL

National Provider Directory

National Provider Directory

Locations

4310 Watermelon Rd
Northport, AL 35473
Phone (205) 330-5266

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1255564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1336474964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 WATERMELON RD",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354735166",
            "telephone_number": "205-330-5266",
            "fax_number": "205-330-9915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 WATERMELON RD",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354735166",
            "telephone_number": "205-330-5266",
            "fax_number": "205-330-9915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SLCM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-15",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "205-710-6129"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336474964",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DP9610",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NorthRiver Primary Care Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Northport, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; 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.