NPIMap

Individual provider Active NPI

Paul Jackson Anderson Jr., MD

  • Diagnostic Radiology Physician
  • Mobile, AL
National Provider Identifier
1578512901
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
5393 Issued in AL
Practice address
2451 Fillingim St
Mastin BLDG. 617
Mobile, AL 36617-2238
Phone
(251) 470-5842
Fax
(251) 470-5809
NPI assigned
May 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 5393 AL Primary

Addresses

Primary practice location

2451 Fillingim St
Mastin BLDG. 617
Mobile, AL 36617-2238

Mailing address

PO Box 1345
Point Clear, AL 36564-1345
Phone (251) 928-9281

Other identifiers 3

IdentifierTypeStateIssuer
16-01418OtherALUNITED HEALTHCARE
51530385OtherALBCBS
06029094MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
5393ALMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Vincent E. Martin, M.D., P.C. Diagnostic Radiology Past Accepting new patients
Alabama Coastal Radiology, PC Past Accepting new patients
Enterprise Radiology PC Diagnostic Radiology PastSince Feb 14, 2005 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1578512901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1345",
            "city": "POINT CLEAR",
            "state": "AL",
            "postal_code": "365641345",
            "telephone_number": "251-928-9281",
            "fax_number": "251-928-9281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2451 FILLINGIM ST",
            "address_2": "MASTIN BLDG. 617",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366172238",
            "telephone_number": "251-470-5842",
            "fax_number": "251-470-5809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "PAUL",
        "middle_name": "JACKSON",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AL",
            "license": "5393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "16-01418",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "51530385",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06029094",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.