Functional Medicine of Alabama, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO-797 Issued in AL

Legal business name

FUNCTIONAL MEDICINE OF ALABAMA, PC

Practice address

2228 Cahaba Valley Dr
Birmingham, AL 35242

Phone

(205) 593-4200

Fax

(205) 672-1009

NPI assigned

Apr 17, 2007

Last updated

Feb 15, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marian Leigh St. Petery, DONPI 1811945280

Title

Physician/Owner

Phone

(205) 593-4200

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Harpersville Family Medicine, PC Former legal business name

Medicare fee-for-service enrollment

Enrolled in AL2 enrollments

Enrollment records 2

Locations

Practitioners 1

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.

• Marian Leigh St. Petery, DO

  • Family Medicine Physician
  • Harpersville, AL
  • NPI 1811945280
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550188800000",
    "number": "1356567721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2228 CAHABA VALLEY DR",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "35242",
            "telephone_number": "205-593-4200",
            "fax_number": "205-672-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2228 CAHABA VALLEY DR",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "35242",
            "telephone_number": "205-593-4200",
            "fax_number": "205-672-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL MEDICINE OF ALABAMA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2019-02-15",
        "status": "A",
        "authorized_official_last_name": "ST. PETERY",
        "authorized_official_first_name": "MARIAN",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "205-593-4200",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "DO-797",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "515-27516",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "K374",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harpersville Family Medicine, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Tara C Fulmer, CRNA
• Fulton Dental, LLC.
• Edward Hendrik Fulton, M.D.
• William Kane Fulton, DMD
• Functional Athletic Rehabilitation & Movement
• Teresa R Funderburg, R.D.
• Kayla Trigg Funderburk, CRNP
• Joel Thomas Funk, M.D.
• Joseph Fuqua
• Tiffany Fuqua, FNP-C

• Family Medicine Physician in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2019; 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.