NPIMap

Organization Active NPI

Rural Health Medical Program, Inc

Doing business as Monroeville Health Center

  • Family Medicine Physician
  • Monroeville, AL
National Provider Identifier
1457994121
Registry record updated Oct 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RURAL HEALTH MEDICAL PROGRAM, INC
Doing business as
Monroeville Health Center
Practice address
3040 S Alabama Ave
Monroeville, AL 36460-5600
Phone
(844) 736-7629
NPI assigned
Oct 24, 2019
Last updated
Oct 24, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2019

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

Authorized official

Name
Keshee Danee Smith
Title
Ceo
Phone
(334) 874-7428

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

3040 S Alabama Ave
Monroeville, AL 36460-5600

Mailing address

101 Park PL
Selma, AL 36701-6764
Phone (334) 874-7428

Other names 1

  • Monroeville Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040506001178 AL Part B Supplier - Clinic/Group Practice 0143219196 Receives reassigned benefits from 42 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Demopolis, AL; Marion, AL; Monroeville, AL; Pine Apple, AL; Selma, AL; Thomaston, AL; Uniontown, AL; Vredenburgh, AL…
O20200407001242 AL MDPP Supplier - in-Person MDPP Supplier 0143219196 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Camden, AL; Demopolis, AL; Marion, AL; Monroeville, AL; Pine Apple, AL; Selma, AL; Thomaston, AL; Uniontown, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457994121. Details of each certification follow.

  • CCN 011078 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 011078

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MONROEVILLE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 9, 2020
Last certification
Sep 9, 2020
Ownership / control type
For profit – partnership
Facility address
3040 S Alabama Ave
Monroeville, AL 36460

Other NPIs on the same Medicare enrollment 10

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2174335Monroeville Health Center3040 S Alabama Ave, Monroeville, AL 36460Provider-performed microscopyOct 29, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 27

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.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1571875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571875200000",
    "number": "1457994121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PARK PL",
            "city": "SELMA",
            "state": "AL",
            "postal_code": "367016764",
            "telephone_number": "334-874-7428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 S ALABAMA AVE",
            "city": "MONROEVILLE",
            "state": "AL",
            "postal_code": "364605600",
            "telephone_number": "844-736-7629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH MEDICAL PROGRAM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-24",
        "last_updated": "2019-10-24",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KESHEE",
        "authorized_official_middle_name": "DANEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-874-7428"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monroeville Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroeville, AL

Sources for this page

Verify at the official NPI Registry.