NPIMap

Organization Active NPI

Medical East of Decatur Inc

  • Rural Health Clinic/Center
  • Decatur, AL
National Provider Identifier
1659518553
Registry record updated May 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MEDICAL EAST OF DECATUR INC
Practice address
2941 Point Mallard Pkwy SE
Ste N
Decatur, AL 35603-5716
Phone
(256) 432-2822
Fax
(256) 432-2825
NPI assigned
Jan 14, 2009
Last updated
May 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2023

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

Authorized official

Name
Michelle S Graham, FNP-CNPI 1255894994
Title
Clinical Director
Phone
(256) 432-2822

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse Practitioner 363LF0000X 1105407 AL

Addresses

Primary practice location

2941 Point Mallard Pkwy SE
Ste N
Decatur, AL 35603-5716

Mailing address

2941 Point Mallard Pkwy SE Ste N
Decatur, AL 35603-5760
Phone (256) 432-2822

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090324000054 AL Part B Supplier - Clinic/Group Practice 4688731409 Receives reassigned benefits from 14 practitioners
Practice locations: Decatur, AL
O20110913000928 AL Part A Provider - Rural Health Clinic 4688731409 Practice locations: Decatur, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659518553. Details of each certification follow.

Rural health clinic certification: CCN 013965

Legal name
MEDICAL EAST OF DECATUR INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 14, 2012
Last certification
Apr 10, 2025
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Dec 2, 2008 in AL
Enrollment address
2941 Point Mallard Pkwy
Decatur, AL 35603-5716

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
01D2001465Medical East of Decatur2941 Point Mallard Parkway Suite a, Decatur, AL 35603Certificate of waiverDec 20, 2027

National Provider Directory

National Provider Directory

Locations

2941 Point Mallard Pkwy SE
Decatur, AL 35603
Phone (256) 432-2822

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Kim L Harbin Individual 5% Or Greater Direct Ownership Interest Sep 1, 2011
W-2 Managing Employee Sep 1, 2011
Michelle Sloan Graham Individual W-2 Managing EmployeeClinical Director Jun 1, 2016 100%

Owners & managing parties with NPI records 2

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1231891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684800000000",
    "number": "1659518553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2941 POINT MALLARD PKWY SE STE N",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356035760",
            "telephone_number": "256-432-2822",
            "fax_number": "256-432-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2941 POINT MALLARD PKWY SE",
            "address_2": "STE N",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356035716",
            "telephone_number": "256-432-2822",
            "fax_number": "256-432-2825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL EAST OF DECATUR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-14",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "256-432-2822",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1105407",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, AL

Sources for this page

Verify at the official NPI Registry.