NPIMap

Organization Active NPI

Druid City Physician Services, LLC

  • Maternal & Fetal Medicine Physician
  • Tuscaloosa, AL
National Provider Identifier
1356911564
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Maternal & Fetal Medicine PhysicianTaxonomy code 207VM0101X
Legal business name
DRUID CITY PHYSICIAN SERVICES, LLC
Practice address
701 University Blvd E Ste 807
Tuscaloosa, AL 35401-7479
Phone
(205) 759-6873
NPI assigned
Jun 29, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Authorized official

Name
Mr. Daniel Clay Conville
Title
Corp Director, Physician Services
Phone
(205) 759-6165

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Maternal & Fetal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VM0101X Primary

Addresses

Primary practice location

701 University Blvd E Ste 807
Tuscaloosa, AL 35401-7479

Mailing address

3901 Greensboro Ave Ste a
Tuscaloosa, AL 35405-3771
Phone (205) 333-4661

Other names 1

  • DCH Maternal Fetal Medicine Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220322000131 AL Part B Supplier - Clinic/Group Practice 1759776107 Receives reassigned benefits from 16 practitioners
2 other NPIs on this enrollment
Practice locations: Reform, AL; Tuscaloosa, AL

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Cardiovascular Care of Alabama4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

701 University Blvd E
Ste 810
Tuscaloosa, AL 35401
Phone (205) 343-8070

3901 Greensboro Ave
Ste A
Tuscaloosa, AL 35405
Phone (205) 759-6165

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1356911564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 GREENSBORO AVE STE A",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354053771",
            "telephone_number": "205-333-4661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 UNIVERSITY BLVD E STE 807",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354017479",
            "telephone_number": "205-759-6873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRUID CITY PHYSICIAN SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-29",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "CONVILLE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "CLAY",
        "authorized_official_title_or_position": "CORP DIRECTOR, PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "205-759-6165",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207VM0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DCH Maternal Fetal Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; 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.