NPIMap

Organization Active NPI

Kids R US Pediatrics LLC

  • Pediatrics Physician
  • Arab, AL
National Provider Identifier
1639718562
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
KIDS R US PEDIATRICS LLC
Practice address
121 Golfview Dr NE
Arab, AL 35016-5473
Phone
(256) 931-5437
Fax
(833) 753-1386
NPI assigned
Dec 23, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Authorized official

Name
Dr. Tonya Renee Miller, MDNPI 1831539790
Title
Physician/Owner
Phone
(256) 931-5437

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

121 Golfview Dr NE
Arab, AL 35016-5473

Mailing address

121 Golfview Dr NE
Arab, AL 35016-5473
Phone (256) 931-5437

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201110001711 AL Part A Provider - Rural Health Clinic 1052721602 Practice locations: Arab, AL

Rural health clinic certification: CCN 018950

Legal name
KIDS R US PEDIATRICS LLC
Doing business as
PEDSONE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 19, 2021
Last certification
Jan 19, 2021
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
in AL
Enrollment address
121 Golfview Dr NE
Arab, AL 35016-5473

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
01D2201225Kids R US Pediatrics121 Golfview Drive NE, Arab, AL 35016Certificate of waiverNov 18, 2026

National Provider Directory

National Provider Directory

Locations

121 Golfview Dr NE
Arab, AL 35016
Phone (256) 931-3531

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tonya Renee Miller Individual 5% Or Greater Direct Ownership InterestOwner/Physician Dec 13, 2020 100%
Corporate OfficerOwner/Physician Dec 13, 2020 100%
Operational/Managerial ControlOwner/Physician Dec 13, 2020 100%

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1577059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1639718562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 GOLFVIEW DR NE",
            "city": "ARAB",
            "state": "AL",
            "postal_code": "350165473",
            "telephone_number": "256-931-5437",
            "fax_number": "833-753-1386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 GOLFVIEW DR NE",
            "city": "ARAB",
            "state": "AL",
            "postal_code": "350165473",
            "telephone_number": "256-931-5437",
            "fax_number": "833-753-1386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS R US PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-23",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "TONYA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "256-931-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arab, AL

Sources for this page

Verify at the official NPI Registry.