Fort Payne Pediatrics, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

FORT PAYNE PEDIATRICS, LLC

Practice address

1359 Old Water Works Rd SW
Fort Payne, AL 35968-3347

Phone

(256) 997-5900

Fax

(256) 997-5995

NPI assigned

Oct 23, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Peter Strogov, M.D.NPI 1295964682

Title

President

Phone

(256) 997-5900

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Rural health clinic certification: CCN 018917

Legal name

FORT PAYNE PEDIATRICS, LLC

Doing business as

FORT PAYNE PEDIATRICS - WATERWORKS

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jun 10, 2015

Last certification

Mar 22, 2023

Ownership / control type

1B

Organization structure

LLCProprietary

Incorporated

Apr 15, 2012 in AL

Enrollment address

1359 Old Waterworks Rd SW
Fort Payne, AL 35968-3369

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

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

Practitioners 5

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

• Peter Strogov, M.D.

  • Pediatrics Physician
  • Fort Payne, AL
  • NPI 1295964682
  NPD (past) Authorized official
• Katie Fleming, NP

  • Pediatric Nurse Practitioner
  • Fort Payne, AL
  • NPI 1952863789
  NPD (past)
• Tiffany Lassetter, CPNP-PC

  • Pediatric Nurse Practitioner
  • Fort Payne, AL
  • NPI 1710685532
  NPD (past)
• Carlie Anastasia Rutledge, CRNP

  • Family Nurse Practitioner
  • Fort Payne, AL
  • NPI 1174277859
  NPD (past)
• Pascha Orr, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Denver, CO
  • NPI 1710619861
  NPD (past)

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

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691452800000",
    "number": "1356746085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1359 OLD WATER WORKS RD SW",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359683347",
            "telephone_number": "256-997-5900",
            "fax_number": "256-997-5995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1359 OLD WATER WORKS RD SW",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359683347",
            "telephone_number": "256-997-5900",
            "fax_number": "256-997-5995"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1359 Old Waterworks Road",
            "address_purpose": "LOCATION",
            "city": "Fort Payne",
            "state": "AL",
            "postal_code": "359683546",
            "country_code": "US",
            "telephone_number": "256-997-5900",
            "fax_number": "256-997-5995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FORT PAYNE PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-23",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A",
        "authorized_official_last_name": "STROGOV",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "256-997-5900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177834",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167395",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fort Payne Hospital Corporation
• Fort Payne Hospital Corporation
• Fort Payne Hospital Organization
• Fort Payne MRI LLC
• Fort Payne Pediatrics LLC
• Fort Payne Pharmacy LLC
• Fort Payne RHC Corp
• Fort Payne Urgent Care, LLC
• Janna Foshee, MS, CCC-SLP
• Ora Gwendolyn Foster, LCSW

• Rural Health Clinic/Center in Fort Payne, AL
• Providers in Fort Payne, AL by specialty
• Rural Health Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.