Active NPI
Darrell Scott Prestridge, DO
- Ophthalmology Physician
- Pelham, AL
National Provider Identifier
1376543801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- D0502
- Practice address
- 2122 Old Montgomery Hwy
Pelham, AL 35124-1138 - Phone
- (205) 621-3437
- Fax
- (205) 621-8550
- NPI assigned
- Jul 27, 2005
- Last updated
- Dec 1, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | D0502 | AL | Primary |
Addresses
Primary practice location
2122 Old Montgomery Hwy
Pelham, AL 35124-1138
Mailing address
PO Box 531326
Birmingham, AL 35253-1326
Phone (205) 621-3437
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 515-33912 | Other | AL | BC BS OF AL |
| 000094295 | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0502 | AL | MD | Ophthalmology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Andalusia Eye Clinic LLC | Ophthalmology | Past | Accepting new patients |
| St Luke's Surgery Center, LLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Ophthalmology Physician
- Pelham, AL
- NPI 1508817198
-
- Ambulatory Surgical Clinic/Center
- Houma, LA
- NPI 1699429415
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448928000000",
"number": "1376543801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 531326",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352531326",
"telephone_number": "205-621-3437",
"fax_number": "205-621-8550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2122 OLD MONTGOMERY HWY",
"city": "PELHAM",
"state": "AL",
"postal_code": "351241138",
"telephone_number": "205-621-3437",
"fax_number": "205-621-8550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRESTRIDGE",
"first_name": "DARRELL",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-27",
"last_updated": "2015-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "AL",
"license": "D0502",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS OF AL",
"identifier": "515-33912",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000094295",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pelham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.