NPIMap

Organization Active NPI

Alabama Providence Healthcare Services

Doing business as Ascension Providence Diabetes Management Program

  • Endocrinology, Diabetes & Metabolism Physician
  • Mobile, AL
National Provider Identifier
1609446087
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
ALABAMA PROVIDENCE HEALTHCARE SERVICES
Doing business as
Ascension Providence Diabetes Management Program
Practice address
6701 Airport Blvd Ste D436
Mobile, AL 36608-6705
Phone
(251) 266-1987
Fax
(251) 266-2070
NPI assigned
Jun 29, 2021
Last updated
Jun 29, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
ALABAMA PROVIDENCE HEALTHCARE SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Authorized official

Name
Miranda Hemm
Title
Enrollment Manager
Phone
(904) 450-6004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NU Primary

Addresses

Primary practice location

6701 Airport Blvd Ste D436
Mobile, AL 36608-6705

Mailing address

6701 Airport Blvd Ste D436
Mobile, AL 36608-6705
Phone (251) 266-1987

Other names 1

  • Ascension Providence Diabetes Management Program Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140127000341 AL Part B Supplier - Clinic/Group Practice 9638308430 Receives reassigned benefits from 110 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mobile, AL; Semmes, AL; Saraland, AL; Robertsdale, AL; Gulf Shores, AL; Fairhope, AL; Citronelle, AL

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Al Prov Hlthcr SRVS27 organizations share this tax ID, including this one
Part of
Al Prov Hlthcr SRVS

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Locations

1700 W 2nd St
Gulf Shores, AL 36542
Phone (251) 677-6770

5621 Cottage Hill Rd
Mobile, AL 36609
Phone (251) 666-2439

8833 Cottage Hill Rd
Mobile, AL 36695
Phone (251) 544-5120

Practitioners & affiliated clinicians

Practitioners 109

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 109

NPI Registry JSON

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

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1609446087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 AIRPORT BLVD STE D436",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366086705",
            "telephone_number": "251-266-1987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 AIRPORT BLVD STE D436",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366086705",
            "telephone_number": "251-266-1987",
            "fax_number": "251-266-2070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALABAMA PROVIDENCE HEALTHCARE SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALABAMA PROVIDENCE HEALTHCARE SERVICES",
        "enumeration_date": "2021-06-29",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-08",
        "status": "A",
        "authorized_official_last_name": "HEMM",
        "authorized_official_first_name": "MIRANDA",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "904-450-6004"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Providence Diabetes Management Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 29, 2021; 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.