Active NPI
Mary J Wade
- Adult Health Nurse Practitioner
- Birmingham, AL
National Provider Identifier
1689687824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 1064337
- Practice address
- 619 19TH Street South
Birmingham, AL 35233 - Phone
- (205) 934-6600
- NPI assigned
- Aug 15, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 1064337 | AL | Primary |
Addresses
Primary practice location
619 19TH Street South
Birmingham, AL 35233
Mailing address
P O Box 55310
Birmingham, AL 35255-5310
Other practice location 1
1830 Montclair Rd Ste A
Irondale, AL 35210-2645
Phone (205) 775-0300
Other practice location 2
109 Foothills Pkwy Ste 113
Chelsea, AL 35043-8236
Phone (205) 618-9899
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 051504939 | Medicaid | AL | |
| 06078723 | Other | AL | MS MEDICAID |
| 051504939 | Other | AL | BCBS OF AL |
| 500021310 | Other | AL | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1064337 | AL | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582588800000",
"number": "1689687824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P O BOX 55310",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352555310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "619 19TH STREET SOUTH",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "35233",
"telephone_number": "205-934-6600"
}
],
"practiceLocations": [
{
"address_1": "1830 Montclair Rd Ste A",
"address_purpose": "LOCATION",
"city": "Irondale",
"state": "AL",
"postal_code": "352102645",
"country_code": "US",
"telephone_number": "205-775-0300",
"fax_number": "205-618-9899",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "109 Foothills Pkwy Ste 113",
"address_purpose": "LOCATION",
"city": "Chelsea",
"state": "AL",
"postal_code": "350438236",
"country_code": "US",
"telephone_number": "205-618-9899",
"fax_number": "205-618-9706",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WADE",
"first_name": "MARY",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-15",
"last_updated": "2020-02-25",
"certification_date": "2020-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "AL",
"license": "1064337",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "051504939",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MS MEDICAID",
"identifier": "06078723",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF AL",
"identifier": "051504939",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "500021310",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.