Samuel Oliver Starke Irvine Jr., PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.189 Issued in AL

Practice address

454 Taylor Rd
Montgomery, AL 36117-3563

Phone

(334) 613-9000

Fax

(334) 532-0056

NPI assigned

May 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Orthopaedic Surgeons LLCGroup PAC ID 9335166685, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Medical Center South Hospital, Montgomery, AL, CCN 010023
• Baptist Medical Center East Hospital, Montgomery, AL, CCN 010149

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Orthopaedic Surgeons, LLC

  • Orthopaedic Surgery Physician
  • Montgomery, AL
  • NPI 1861432239
  Medicare reassignment Care Compare group NPD
• University of Alabama Health Services Foundation, PC.

  • Multi-Specialty Clinic/Center
  • Birmingham, AL
  • NPI 1093768723
  Medicare reassignment
• Southern Orthopaedic Surgeons, LLC

  • Durable Medical Equipment & Medical Supplies
  • Montgomery, AL
  • NPI 1669266599
  NPD
• University of Alabama Health Services Foundation, PC

  • Clinical Medical Laboratory
  • Birmingham, AL
  • NPI 1164617205
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Health Care Authority for Baptist Health an Affiliate of Uabhs

  • General Acute Care Hospital
  • Montgomery, AL
  • NPI 1104917780
  Care Compare affiliation
• Health Care Authority for Baptist Health, an Affiliate of Uabhs

  • General Acute Care Hospital
  • Montgomery, AL
  • NPI 1700977105
  Care Compare affiliation

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1376590059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 TAYLOR RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173563",
            "telephone_number": "334-613-9000",
            "fax_number": "334-532-0056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 TAYLOR RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173563",
            "telephone_number": "334-613-9000",
            "fax_number": "334-532-0056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2871 acton road",
            "address_2": "suite 100",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "352432560",
            "country_code": "US",
            "telephone_number": "205-939-0023",
            "fax_number": "205-939-4180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IRVINE",
        "first_name": "SAMUEL",
        "middle_name": "OLIVER STARKE",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-28",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AL",
            "license": "PA-189",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA.189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009934027",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009989995",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009989985",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS - 860 MONT RD",
            "identifier": "051001143",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS - 48 MED PARK",
            "identifier": "051001307",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS - 2660 10TH AV",
            "identifier": "051001308",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• International Rehabilitative Sciences Inc.
• Mandy Rochelle Irby, LICSW
• Christopher Ireland, DPT
• Mohammad Irfan, M.D.
• Shubhada Iruvanti, D.O
• Michael Dennis Irwin, DMD
• Linda Carroll Isaac
• Isd Renal Inc
• Isd Renal Inc
• George M. Ishman, ALC

• Physician Assistant in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.