NPIMap

Organization Active NPI

South Alabama Family Care, LLC

  • Rural Health Clinic/Center
  • Grand Bay, AL
National Provider Identifier
1649028960
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTH ALABAMA FAMILY CARE, LLC
Practice address
10067 Grand Bay Wilmer Rd S Ste 100
Grand Bay, AL 36541-5003
Phone
(251) 810-9525
Fax
(251) 810-9536
NPI assigned
May 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

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

Authorized official

Name
Bridgot Peters
Title
Billing Director
Phone
(251) 445-7618

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

10067 Grand Bay Wilmer Rd S Ste 100
Grand Bay, AL 36541-5003

Mailing address

10075 Grand Bay Wilmer Rd S
Grand Bay, AL 36541-5003
Phone (251) 865-1852

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240705000929 AL Part B Supplier - Clinic/Group Practice 0042754715 Receives reassigned benefits from 12 practitioners
Practice locations: Grand Bay, AL
O20250110002797 AL Part A Provider - Rural Health Clinic 0042754715 Practice locations: Grand Bay, AL

Rural health clinic certification: CCN 018984

Legal name
SOUTH ALABAMA FAMILY CARE, LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 25, 2025
Last certification
Feb 25, 2025
Ownership / control type
1C
Organization structure
LLCProprietary
Enrollment address
10067 Grand Bay Wilmer Rd S
Ste 100
Grand Bay, AL 36541-5003

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
01D2305877South Alabama Family Care10067 Grand Bay Wilmer Rd S, Grand Bay, AL 36541Certificate of waiverJun 6, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Cherri Bedwell Individual Corporate Officer Sep 1, 2024
W-2 Managing EmployeeCoo Sep 1, 2024
Lloyd S Stokes Individual 5% Or Greater Direct Ownership InterestManaging Partner Sep 1, 2024 28.34%
Corporate OfficerManaging Partner Sep 1, 2024
W-2 Managing EmployeeManaging Partner Sep 1, 2024
Justin Stokes Individual 5% Or Greater Direct Ownership InterestPartner N/a Sep 1, 2024 15%
Corporate OfficerPartner N/a Sep 1, 2024
Robert E Vickers Individual 5% Or Greater Direct Ownership InterestPartner/Medical Director Sep 1, 2024 28.33%
Corporate DirectorPartner/Medical Director Sep 1, 2024
Darren Waters Individual 5% Or Greater Direct Ownership InterestPartner Sep 1, 2024 28.33%
Corporate OfficerPartner Sep 1, 2024

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 12

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": "1715299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1649028960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10075 GRAND BAY WILMER RD S",
            "city": "GRAND BAY",
            "state": "AL",
            "postal_code": "365415003",
            "telephone_number": "251-865-1852",
            "fax_number": "251-865-1854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10067 GRAND BAY WILMER RD S STE 100",
            "city": "GRAND BAY",
            "state": "AL",
            "postal_code": "365415003",
            "telephone_number": "251-810-9525",
            "fax_number": "251-810-9536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ALABAMA FAMILY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-10",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "BRIDGOT",
        "authorized_official_title_or_position": "BILLING DIRECTOR",
        "authorized_official_telephone_number": "251-445-7618"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Bay, AL

Sources for this page

Verify at the official NPI Registry.