NPIMap

Organization Active NPI

MCMD LLC

  • Primary Care Clinic/Center
  • Athens, AL
National Provider Identifier
1477068468
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
32665 Issued in AL
Legal business name
MCMD LLC
Practice address
22292 US Highway 72
Athens, AL 35613-2604
Phone
(256) 614-2444
NPI assigned
Dec 12, 2017
Last updated
Mar 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2022

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

Authorized official

Name
Dr. Matthew Bragg Caldwell, MDNPI 1619236064
Title
Physician
Phone
(256) 614-2444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 32665 AL Primary

Addresses

Primary practice location

22292 US Highway 72
Athens, AL 35613-2604

Mailing address

22292 US Highway 72
Athens, AL 35613-2604
Phone (256) 614-2444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180618001117 AL Part B Supplier - Clinic/Group Practice 7618222597 Receives reassigned benefits from 3 practitioners
Practice locations: Athens, AL

National Provider Directory

National Provider Directory

Locations

101 Fitness Way
Ste 1200
Athens, AL 35611
Phone (256) 232-0636

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1513036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1477068468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22292 US HIGHWAY 72",
            "city": "ATHENS",
            "state": "AL",
            "postal_code": "356132604",
            "telephone_number": "256-614-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22292 US HIGHWAY 72",
            "city": "ATHENS",
            "state": "AL",
            "postal_code": "356132604",
            "telephone_number": "256-614-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-12",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "CALDWELL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "BRAGG",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "256-614-2444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AL",
            "license": "32665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.