NPIMap

Organization Active NPI

Chilton Medical Group P C

  • Legal Medicine
  • Clanton, AL
National Provider Identifier
1629121553
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
Legal business name
CHILTON MEDICAL GROUP P C
Practice address
108 Medical Center Dr
Clanton, AL 35045-2332
Phone
(205) 755-5700
Fax
(888) 418-7660
NPI assigned
Jan 22, 2007
Last updated
Mar 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2024

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

Authorized official

Name
Heather Renee Gann
Title
Administrator
Phone
(205) 755-5700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal Medicine 173000000X Primary

Addresses

Primary practice location

108 Medical Center Dr
Clanton, AL 35045-2332

Mailing address

108 Medical Center Dr
Clanton, AL 35045-2332
Phone (205) 755-5700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051109001015 AL Part B Supplier - Clinic/Group Practice 9638197460 Receives reassigned benefits from 6 practitioners
Practice locations: Clanton, AL

National Provider Directory

National Provider Directory

Locations

1013 Lay Dam Rd
Clanton, AL 35045
Phone (205) 280-4565

Practitioners & affiliated clinicians

Practitioners 7

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": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1629121553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 MEDICAL CENTER DR",
            "city": "CLANTON",
            "state": "AL",
            "postal_code": "350452332",
            "telephone_number": "205-755-5700",
            "fax_number": "205-755-4966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 MEDICAL CENTER DR",
            "city": "CLANTON",
            "state": "AL",
            "postal_code": "350452332",
            "telephone_number": "205-755-5700",
            "fax_number": "888-418-7660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILTON MEDICAL GROUP P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A",
        "authorized_official_last_name": "GANN",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "205-755-5700"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clanton, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; 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.