Individual provider Active NPI

Regan Woodham, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Dothan, AL
National Provider Identifier
1467064089
Registry record updated Nov 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
1-163019 Issued in AL
Practice address
1450 Ross Clark Cir Ste 400
Dothan, AL 36301-4770
Phone
(334) 305-0400
NPI assigned
Aug 17, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 1-163019 AL Primary

Addresses

Primary practice location

1450 Ross Clark Cir Ste 400
Dothan, AL 36301-4770

Mailing address

1450 Ross Clark Cir Ste 400
Dothan, AL 36301-4770
Phone (334) 305-0400

Other practice location 1

4370 W Main St
Dothan, AL 36305-4000
Phone (334) 794-5000

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20201109001708 AL Practitioner - Nurse Practitioner 9335559012 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pulmonary Associates, PAGroup PAC ID 8022031475, 14 clinicians

Practice addresses (Care Compare)

1450 Ross Clark Cir
Suite 400
Dothan, AL 36301-4770
Phone (334) 305-0400

Hospital & facility affiliations

  • Southeast Health Medical Center Hospital, Dothan, AL, CCN 010001
  • Flowers Hospital Hospital, Dothan, AL, CCN 010055
  • Medical Center Enterprise Hospital, Enterprise, AL, CCN 010049

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pulmonary Associates, PA CurrentSince Oct 31, 2022 Accepting new patients
App of Alabama Ed PLLC CurrentSince Oct 1, 2020 Accepting new patients
Flowers HB Medical Services LLC CurrentSince Oct 8, 2023 Accepting new patients

Locations

4370 W Main St
Dothan, AL 36305
Phone (256) 332-1611

1450 Ross Clark Cir
Ste 400
Dothan, AL 36301
Phone (334) 305-0400

5121 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 436-6556

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.146033

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1597622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668124800000",
    "number": "1467064089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 ROSS CLARK CIR STE 400",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363014770",
            "telephone_number": "334-305-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 ROSS CLARK CIR STE 400",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363014770",
            "telephone_number": "334-305-0400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4370 W Main St",
            "address_purpose": "LOCATION",
            "city": "Dothan",
            "state": "AL",
            "postal_code": "363054000",
            "country_code": "US",
            "telephone_number": "334-794-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOODHAM",
        "first_name": "REGAN",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-17",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AL",
            "license": "1-163019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.