NPIMap

Organization Active NPI

Pell City Internal Medicine LLC

Doing business as Pell City Internal and Family Medicine

  • Family Medicine Physician
  • Pell City, AL
National Provider Identifier
1649539610
Registry record updated Feb 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
27238 Issued in AL
Legal business name
PELL CITY INTERNAL MEDICINE LLC
Doing business as
Pell City Internal and Family Medicine
Practice address
41 Eminence Way Ste a
Pell City, AL 35128-2338
Phone
(205) 884-9000
Fax
(205) 884-8111
NPI assigned
May 11, 2012
Last updated
Feb 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2022

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

Authorized official

Name
Terri Woods
Title
Office Administrator
Phone
(205) 884-9000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 27238 AL Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 22922 AL

Addresses

Primary practice location

41 Eminence Way Ste a
Pell City, AL 35128-2338

Mailing address

41 Eminence Way Ste a
Pell City, AL 35128-2338
Phone (205) 884-9000

Other names 1

  • Pell City Internal and Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120802000650 AL Part B Supplier - Clinic/Group Practice 0648426825 Receives reassigned benefits from 11 practitioners
Practice locations: Pell City, AL

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
01D2041950Pell City Internal and Family Medicine41 Eminence Way Suite a, Pell City, AL 35128Certificate of waiverJul 18, 2028

National Provider Directory

National Provider Directory

Locations

41 Eminence Way
Ste A
Pell City, AL 35128
Phone (205) 206-4518

Practitioners & affiliated clinicians

Practitioners 11

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": "1336694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644883200000",
    "number": "1649539610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 EMINENCE WAY STE A",
            "city": "PELL CITY",
            "state": "AL",
            "postal_code": "351282338",
            "telephone_number": "205-884-9000",
            "fax_number": "205-884-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 EMINENCE WAY STE A",
            "city": "PELL CITY",
            "state": "AL",
            "postal_code": "351282338",
            "telephone_number": "205-884-9000",
            "fax_number": "205-884-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELL CITY INTERNAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-11",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A",
        "authorized_official_last_name": "WOODS",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "205-884-9000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "27238",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "22922",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pell City Internal and Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pell City, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.