NPIMap

Organization Active NPI

Northeast Alabama Health Services, Inc.

Doing business as Northeast Alabama Health Services Inc - North Sand Mountain

  • Federally Qualified Health Center (FQHC)
  • Bryant, AL
National Provider Identifier
1356498505
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST ALABAMA HEALTH SERVICES, INC.
Doing business as
Northeast Alabama Health Services Inc - North Sand Mountain
Practice address
29810 Al Highway 71
Bryant, AL 35958-5240
Phone
(256) 597-4114
Fax
(256) 597-4115
NPI assigned
Jan 3, 2007
Last updated
May 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHEAST ALABAMA HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 28, 2024

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

Authorized official

Name
James P Allen Jr.
Title
Ceo
Phone
(256) 259-5313

Specialties & licenses 1

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

Addresses

Primary practice location

29810 Al Highway 71
Bryant, AL 35958-5240

Mailing address

29810 Al Highway 71
Bryant, AL 35958-5240
Phone (256) 597-4114

Other names 1

  • NORTHEAST ALABAMA HEALTH SERVICES INC - NORTH SAND MOUNTAIN Doing business as

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20030312000004 AL Part A Provider - Federally Qualified Health Center (FQHC) 4082522883 Practice locations: Bryant, AL
O20030910000046 AL Part A Provider - Federally Qualified Health Center (FQHC) 4082522883 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Scottsboro, AL
O20040120000485 AL Part B Supplier - Clinic/Group Practice 4082522883 Receives reassigned benefits from 17 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bryant, AL; Fort Payne, AL; Fyffe, AL; Scottsboro, AL; Section, AL; Woodville, AL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1356498505. Details of each certification follow.

Federally qualified health center certification: CCN 011922

Legal name
NORTHEAST ALABAMA HEALTH SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 4, 2003
Last certification
Jun 4, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 28, 1978 in AL
Enrollment address
29810 Al Highway 71
Bryant, AL 35958-5240

Federally qualified health center certification: CCN 011905

Legal name
NORTHEAST ALABAMA HEALTH SERVICES, INC.
Doing business as
SKYLINE PRIMARY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 12, 2000
Last certification
Jul 12, 2000
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 28, 1978 in AL
Enrollment address
21680 Alabama Highway 79
Scottsboro, AL 35768-5904

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 3

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

National Provider Directory

National Provider Directory
Part of
Scottsboro Primary Heal

Locations

34617 AL Highway 75
Fyffe, AL 35971
Phone (256) 623-5242

302 Main St S
Section, AL 35771
Phone (256) 228-3471

13624 County Road 8
Woodville, AL 35776
Phone (256) 776-5615

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Jannette D Haley Individual Corporate DirectorBoard Member Aug 23, 2022
Corporate Director Aug 23, 2022
Sylvia Nell Martin Individual Corporate DirectorBoard Member Oct 27, 1998
Corporate Director Aug 1, 2010
Charles W Murphree Individual Corporate DirectorBoard Member Oct 27, 1998
Corporate Director Aug 1, 2010
Leshia Wilhelm Individual Corporate OfficerCorporate Compliance Officer/DO Mar 10, 2021
W-2 Managing EmployeeDirector of Oper/Corp Compliance of Mar 1, 2013
W-2 Managing Employee Aug 1, 2010
Tiffany Graben Individual Corporate DirectorBoard Member Jul 28, 2020
Melissa Campbell Individual Corporate DirectorBoard Member Aug 22, 2006
Corporate Director Aug 1, 2010
Keshia L Gardner Individual Corporate DirectorBoard Member Jan 26, 2016
Madel R Brown Individual Corporate DirectorBoard Member May 17, 2016
Amanda L Foshee Individual W-2 Managing EmployeeMedical Director/Physician Jun 2, 2023
W-2 Managing EmployeeMD; Jun 2, 2023
Paul B Jones Individual Corporate DirectorBoard Member Mar 26, 2019
Angela R Saint Individual Corporate OfficerChief Financial Officer Jan 16, 2015
W-2 Managing EmployeeChief Financial Officer Mar 1, 2013
W-2 Managing Employee Aug 1, 2010
Gayla Bass Individual Corporate DirectorBoard Member Jun 1, 2014
James P Allen Individual W-2 Managing EmployeeChief Executive Officer Apr 29, 2024

Owners & managing parties with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1356498505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29810 AL HIGHWAY 71",
            "city": "BRYANT",
            "state": "AL",
            "postal_code": "359585240",
            "telephone_number": "256-597-4114",
            "fax_number": "256-597-4115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29810 AL HIGHWAY 71",
            "city": "BRYANT",
            "state": "AL",
            "postal_code": "359585240",
            "telephone_number": "256-597-4114",
            "fax_number": "256-597-4115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ALABAMA HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST ALABAMA HEALTH SERVICES, INC.",
        "enumeration_date": "2007-01-03",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "256-259-5313",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHEAST ALABAMA HEALTH SERVICES INC - NORTH SAND MOUNTAIN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bryant, AL

Sources for this page

Verify at the official NPI Registry.