Active NPI
Julian Jerrod Jesubatham, MD
- Internal Medicine Physician
- Gulf Shores, AL
National Provider Identifier
1659682904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD.36071
- Practice address
- 200 Office Park Dr
Gulf Shores, AL 36542-3432 - Phone
- (251) 968-7379
- Fax
- (251) 968-5960
- NPI assigned
- Jul 1, 2010
- Last updated
- Nov 13, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD.36071 | AL | Primary |
Addresses
Primary practice location
200 Office Park Dr
Gulf Shores, AL 36542-3432
Mailing address
200 Office Park Dr
Gulf Shores, AL 36542-3432
Phone (251) 968-7379
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 244212 | Medicaid | AL |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | julian.jesubatham.3@1599.direct.athenahealth.com | ||
| Direct Messaging Address | julian.jesubatham.3@1599.direct.athenahealth.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
350 Cypress Bend Blvd
Suite 104
Gulf Shores, AL 36542-2773
Phone (251) 929-3424
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD.36071 | AL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Imc-Eastern Shore Adult Medicine, LLC | Internal Medicine | Current | Accepting new patients |
Locations
300 Greeno Rd S
Fairhope, AL 36532
Phone (251) 928-9560
300 Greeno Rd S
#B
Fairhope, AL 36532
Phone (251) 929-3424
350 Cypress Bend Blvd
Ste 104
Gulf Shores, AL 36542
Phone (251) 929-3424
Interoperability endpoints
- jjesubatham111607@directinfirmaryhealth.org
- julian.jesubatham.3@1599.direct.athenahealth.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Internal Medicine Physician
- Fairhope, AL
- NPI 1912284852
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Centerwell Home Health
- Home Health Agency
- Foley, AL
- NPI 1306875059
-
dba Thomas Hospital
- General Acute Care Hospital
- Fairhope, AL
- NPI 1447303227
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605225600000",
"number": "1659682904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 OFFICE PARK DR",
"city": "GULF SHORES",
"state": "AL",
"postal_code": "365423432",
"telephone_number": "251-968-7379",
"fax_number": "251-968-5960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 OFFICE PARK DR",
"city": "GULF SHORES",
"state": "AL",
"postal_code": "365423432",
"telephone_number": "251-968-7379",
"fax_number": "251-968-5960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JESUBATHAM",
"first_name": "JULIAN",
"middle_name": "JERROD",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-07-01",
"last_updated": "2020-11-13",
"certification_date": "2020-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AL",
"license": "MD.36071",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "244212",
"state": "AL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "julian.jesubatham.3@1599.direct.athenahealth.com",
"affiliation": "N",
"endpointDescription": "AMR Direct Address",
"address_1": "2103 W. 1st St",
"city": "Gulf Shores",
"state": "AL",
"country_code": "US",
"postal_code": "36542",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "julian.jesubatham.3@1599.direct.athenahealth.com",
"affiliation": "N",
"endpointDescription": "AMR Direct Address",
"address_1": "200 Office Park Dr",
"city": "Gulf Shores",
"state": "AL",
"country_code": "US",
"postal_code": "365423432",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Gulf Shores, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.