NPIMap

Organization Active NPI

Pickens County Primary Care, P.C

  • Rural Health Clinic/Center
  • Reform, AL
National Provider Identifier
1508332446
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PICKENS COUNTY PRIMARY CARE, P.C
Practice address
815 7TH Ave SW
Reform, AL 35481
Phone
(205) 375-2438
Fax
(205) 375-2439
NPI assigned
Oct 18, 2018
Last updated
Feb 19, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PICKENS COUNTY PRIMARY CARE, P.CAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

815 7TH Ave SW
Reform, AL 35481

Mailing address

108 4TH Ave SW Ste a
Reform, AL 35481-8018
Phone (205) 375-6251

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200509000003 AL Part B Supplier - Clinic/Group Practice 1658597307 Receives reassigned benefits from 13 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Reform, AL; Gordo, AL; Carrollton, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508332446. Details of each certification follow.

Rural health clinic certification: CCN 018940

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
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
815 7TH Avenue SW
Reform, AL 35481

Other NPIs on the same Medicare enrollment 4

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
01D2167707Pickens County Primary Care PC815 7TH Ave SW, Reform, AL 35481Certificate of waiverJun 12, 2027

National Provider Directory

National Provider Directory
Part of
Pickens County Primary Care

Locations

815 7th Ave SW
Reform, AL 35481
Phone (205) 375-2438

Practitioners & affiliated clinicians

Practitioners 5

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": "1539820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1508332446",
    "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": "205-375-9064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 7TH AVE SW",
            "city": "REFORM",
            "state": "AL",
            "postal_code": "35481",
            "telephone_number": "205-375-2438",
            "fax_number": "205-375-2439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PICKENS COUNTY PRIMARY CARE, P.C",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PICKENS COUNTY PRIMARY CARE, P.C",
        "enumeration_date": "2018-10-18",
        "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": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reform, AL

Sources for this page

Verify at the official NPI Registry.