NPIMap

Organization Active NPI

Springville Pediatrics LLC

  • Pediatrics Physician
  • Springville, AL
National Provider Identifier
1689187080
Registry record updated May 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SPRINGVILLE PEDIATRICS LLC
Practice address
350 Springville Station Blvd
Springville, AL 35146
Phone
(256) 490-0361
NPI assigned
Nov 8, 2017
Last updated
May 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2020

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

Authorized official

Name
Mrs. Monica Chadwick, CPNPNPI 1356682173
Title
Owner
Phone
(256) 490-0361

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU
Nurse Practitioner 363L00000X NU
Family Nurse Practitioner 363LF0000X NU
Pediatric Nurse Practitioner 363LP0200X NU
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

350 Springville Station Blvd
Springville, AL 35146

Mailing address

350 Springville Sta
Springville, AL 35146-6163

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180320002600 AL Part A Provider - Rural Health Clinic 5496017048 Practice locations: Springville, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689187080. Details of each certification follow.

Rural health clinic certification: CCN 018931

Legal name
SPRINGVILLE PEDIATRICS LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 14, 2018
Last certification
Dec 17, 2025
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Aug 30, 2017 in AL
Enrollment address
350 Springville Station Boulevard
Springville, AL 35146-6163

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
01D2141283Springville Pediatrics LLC350 Springville Station Blvd, Springville, AL 35146Certificate of waiverDec 10, 2027

National Provider Directory

National Provider Directory

Locations

350 Springville Sta
Springville, AL 35146
Phone (205) 773-2075

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
Monica M Chadwick Individual 5% Or Greater Direct Ownership InterestVice President Aug 29, 2017 50%
Corporate OfficerVice President Aug 29, 2017 50%
W-2 Managing EmployeeVice President Aug 29, 2017 50%
Operational/Managerial ControlVice President Aug 29, 2017 50%
Peter Strogov Individual 5% Or Greater Direct Ownership InterestPresident Aug 29, 2017 50%
Corporate OfficerPresident Aug 29, 2017 50%
W-2 Managing EmployeePresident Aug 29, 2017 50%
Operational/Managerial ControlPresident Aug 29, 2017 50%

Practitioners & affiliated clinicians

Practitioners 12

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": "1510099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588809600000",
    "number": "1689187080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 SPRINGVILLE STA",
            "city": "SPRINGVILLE",
            "state": "AL",
            "postal_code": "351466163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 SPRINGVILLE STATION BLVD",
            "city": "SPRINGVILLE",
            "state": "AL",
            "postal_code": "35146",
            "telephone_number": "256-490-0361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGVILLE PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-08",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A",
        "authorized_official_last_name": "CHADWICK",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-490-0361",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springville, AL

Sources for this page

Verify at the official NPI Registry.