NPIMap

Organization Active NPI

Houston County Healthcare Authority

Doing business as SAMC-Hospitalists

  • Internal Medicine Physician
  • Dothan, AL
National Provider Identifier
1659566651
Registry record updated Nov 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
HOUSTON COUNTY HEALTHCARE AUTHORITY
Doing business as
SAMC-Hospitalists
Practice address
1108 Ross Clark Cir
Dothan, AL 36301-3022
Phone
(334) 793-8087
Fax
(334) 793-8191
NPI assigned
Sep 12, 2007
Last updated
Nov 12, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
HOUSTON COUNTY HEALTH CARE AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 12, 2007

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

Authorized official

Name
Mr. Derek Miller, CFO
Title
Chief Financial Officer
Phone
(334) 793-8087

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU
Internal Medicine Physician 207R00000X NU Primary
Pulmonary Disease Physician 207RP1001X NU

Addresses

Primary practice location

1108 Ross Clark Cir
Dothan, AL 36301-3022

Mailing address

PO Box 1928
Dothan, AL 36302-1928
Phone (334) 793-8087

Other identifiers 1

IdentifierTypeStateIssuer
W167OtherALBCBS OF AL GROUP NUMBER

Other names 1

  • SAMC-Hospitalists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040219000209 AL Part B Supplier - Clinic/Group Practice 9436062296 Receives reassigned benefits from 540 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dothan, AL; Elba, AL; Enterprise, AL; Eufaula, AL; Midland City, AL; Taylor, AL; Troy, AL; Ashford, AL

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Southeast Alabama Med C17 organizations share this tax ID, including this one
Part of
Southeast Alabama Med C

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Practitioners & affiliated clinicians

Practitioners 8

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": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194825600000",
    "number": "1659566651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1928",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363021928",
            "telephone_number": "334-793-8087",
            "fax_number": "334-793-8191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 ROSS CLARK CIR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013022",
            "telephone_number": "334-793-8087",
            "fax_number": "334-793-8191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOUSTON COUNTY HEALTHCARE AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOUSTON COUNTY HEALTH CARE AUTHORITY",
        "enumeration_date": "2007-09-12",
        "last_updated": "2007-11-12",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "334-793-8087",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF AL  GROUP NUMBER",
            "identifier": "W167",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAMC-Hospitalists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.