NPIMap

Individual provider Active NPI

Jeffrey M Elliott, MD

  • Internal Medicine Physician
  • Dothan, AL
National Provider Identifier
1639138795
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
00025008 Issued in AL
Practice address
1901 Melba Dr
Dothan, AL 36301-3017
Phone
(334) 794-6611
Fax
(334) 794-6614
NPI assigned
Mar 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 00025008 AL Primary

Addresses

Primary practice location

1901 Melba Dr
Dothan, AL 36301-3017

Mailing address

1901 Melba Dr
Dothan, AL 36301-3017
Phone (334) 794-6611

Other identifiers 2

IdentifierTypeStateIssuer
000021979MedicaidAL
051521979OtherALBLUE CROSS & BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040708000710 AL Practitioner - Internal Medicine 0840278776 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Indiana University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Clinic PCGroup PAC ID 1355329269, 25 clinicians

Practice addresses (Care Compare)

201 Doctors Dr
Dothan, AL 36301-2949
Phone (334) 794-6611

Hospital & facility affiliations

  • Amedisys Home Health Home health agency, Dothan, AL, CCN 017159
  • Enhabit Home Health Home health agency, Dothan, AL, CCN 017053
  • Centerwell Home Health Home health agency, Dothan, AL, CCN 017164
  • Southeast Alabama Homecare Home health agency, Dothan, AL, CCN 017024
  • Centerwell Home Health Home health agency, Bainbridge, GA, CCN 117151
  • Southeast Health Medical Center Hospital, Dothan, AL, CCN 010001
  • Flowers Hospital Hospital, Dothan, AL, CCN 010055
  • Encompass Health Rehabilitation Hospital of Dothan Inpatient rehabilitation facility, Dothan, AL, CCN 013030

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00025008ALMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Houston County Healthcare Authority Current Accepting new patients
Houston County Healthcare Authority Internal Medicine Current Accepting new patients
Southern Clinic PC Internal Medicine CurrentSince Jul 15, 2004 Accepting new patients
Houston County Healthcare Authority Internal Medicine CurrentSince Jul 15, 2004 Accepting new patients
Houston County Healthcare Authority Internal Medicine CurrentSince Jul 15, 2004 Accepting new patients
Encompass Health Rehabilitation Hospital of Dothan, Inc Past Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

201 Doctors Dr
Dothan, AL 36301
Phone (334) 794-6611

1901 Melba Dr
Dothan, AL 36301
Phone 334793808752

1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1720

Organizations & group practices 7

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195516800000",
    "number": "1639138795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 MELBA DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013017",
            "telephone_number": "334-794-6611",
            "fax_number": "334-794-6614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 MELBA DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013017",
            "telephone_number": "334-794-6611",
            "fax_number": "334-794-6614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "JEFFREY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-18",
        "last_updated": "2007-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "00025008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000021979",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "051521979",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.