Pickens County Primary Care, PC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PICKENS COUNTY PRIMARY CARE, PC

Practice address

205 4TH Ave
Reform, AL 35481

Phone

(205) 375-2304

Fax

(205) 375-2335

NPI assigned

Oct 24, 2018

Last updated

Feb 19, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

PICKENS COUNTY PRIMARY CAREAs reported in NPPES

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

Authorized official

Name

Julia L Boothe, MDNPI 1255397824

Title

Owner

Phone

(205) 792-6701

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437626868. Details of each certification follow.

• CCN 018941 Rural health clinic · Active · Name & address match · Details

Rural health clinic certification: CCN 018941

Legal name

PICKENS COUNTY PRIMARY CARE PC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Dec 4, 2019

Last certification

Dec 4, 2019

Ownership / control type

1B

Facility address

205 4TH Avenue SE
Reform, AL 35481

Other NPIs on the same Medicare enrollment 4

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

• Pickens County Primary Care PC

  • Rural Health Clinic/Center
  • Carrollton, AL
  • NPI 1982205753

  O20200509000003

  Same enrollment
• Pickens County Primary Care, P.C

  • Rural Health Clinic/Center
  • Gordo, AL
  • NPI 1063988806

  O20200509000003

  Same enrollment
• Pickens County Primary Care, P.C

  • Rural Health Clinic/Center
  • Reform, AL
  • NPI 1508332446

  O20200509000003

  Same enrollment
• Pickens County Primary Care, PC

  • Rural Health Clinic/Center
  • Gordo, AL
  • NPI 1295421667

  O20200509000003

  Same enrollment

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

CLIA laboratory certificates

Part of

Pickens County Primary Care

Practitioners 3

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.

• Julia Lett Boothe, M.D.

  • Family Medicine Physician
  • Reform, AL
  • NPI 1255397824
  Authorized official Same address or phone
• Cacyce Fowler

  • Family Nurse Practitioner
  • Reform, AL
  • NPI 1457774200
  NPD
• Brandy Junkin, CRNP

  • Family Nurse Practitioner
  • Tuscaloosa, AL
  • NPI 1902259443
  NPD

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

{
    "created_epoch": "1540339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1437626868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 4TH AVE SW STE A",
            "city": "REFORM",
            "state": "AL",
            "postal_code": "354818018",
            "telephone_number": "205-375-6251",
            "fax_number": "205-375-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 4TH AVE",
            "city": "REFORM",
            "state": "AL",
            "postal_code": "35481",
            "telephone_number": "205-375-2304",
            "fax_number": "205-375-2335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PICKENS COUNTY PRIMARY CARE, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PICKENS COUNTY PRIMARY CARE",
        "enumeration_date": "2018-10-24",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "BOOTHE",
        "authorized_official_first_name": "JULIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "205-792-6701",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pickens County Health Care Authority (Reform Primary Care Clinic)
• Pickens County Medical Center, Inc (Reform Primary Care Clinic)
• Pickens County Medical Center, Inc (Reform Primary Care)
• Pickens County Primary Care PC
• Pickens County Primary Care, P.C
• Theresa Darlene Putman, CRNP
• Reform Medical Clinic (Harry L Richardson)
• Reform Pharmacy Inc
• Reform Rural Health Center PC
• Harry Lee Richardson Jr., MD

• Rural Health Clinic/Center in Reform, AL
• Providers in Reform, 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 Feb 19, 2020; 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.