Individual provider Active NPI

Colin Thomas Buckley

  • Surgery Physician
  • Fairhope, AL
National Provider Identifier
1669978359
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD.39153 Issued in AL
Practice address
188 Hospital Dr Ste 205
Fairhope, AL 36532-2038
Phone
(251) 990-9191
Fax
(251) 990-9189
NPI assigned
Apr 2, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD.39153 AL Primary

Addresses

Primary practice location

188 Hospital Dr Ste 205
Fairhope, AL 36532-2038

Mailing address

3 Mobile Infirmary Cir Ste 305
Mobile, AL 36607-3515
Phone (251) 990-9191

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240726002670 AL Practitioner - General Surgery 6305199100 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Oklahoma College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Imc-Cancer Surgery of Mobile, LLCGroup PAC ID 1557550589, 23 clinicians

Practice addresses (Care Compare)

188 Hospital Dr
Suite 205
Fairhope, AL 36532-2038
Phone (251) 990-9191

Hospital & facility affiliations

  • Thomas Hospital Hospital, Fairhope, AL, CCN 010100

Merit-based Incentive Payment System (MIPS)

Final score
95.26 of 100Reported as group
Promoting interoperability
93
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)22
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD.39153ALMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Imc-Cancer Surgery of Mobile, LLC CurrentSince Jul 29, 2024 Accepting new patients

Locations

188 Hospital Dr
Ste 205
Fairhope, AL 36532
Phone (251) 990-3701

3 Mobile Infirmary Cir
Ste 305
Mobile, AL 36607
Phone (251) 433-5557

Interoperability endpoints

  • Direct secure messaging: cbuckley119134@directinfirmaryhealth.org

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 and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1669978359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 MOBILE INFIRMARY CIR STE 305",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366073515",
            "telephone_number": "251-990-9191",
            "fax_number": "251-990-9189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 HOSPITAL DR STE 205",
            "city": "FAIRHOPE",
            "state": "AL",
            "postal_code": "365322038",
            "telephone_number": "251-990-9191",
            "fax_number": "251-990-9189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "COLIN",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-02",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AL",
            "license": "MD.39153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairhope, AL

Sources for this page

Verify at the official NPI Registry.