NPIMap

Individual provider Active NPI

Anthony Roland Spedale Jr., MD

  • Internal Medicine Physician
  • Dothan, AL
National Provider Identifier
1699778662
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
22862 Issued in AL
Practice address
210 Westside Dr
Dothan, AL 36303-1928
Phone
(334) 793-5074
Fax
(334) 793-6460
NPI assigned
May 24, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 24418 LA
Internal Medicine Physician 207R00000X 22862 AL Primary

Addresses

Primary practice location

210 Westside Dr
Dothan, AL 36303-1928

Mailing address

3113 Wesley Way Ste 1
Dothan, AL 36305-2004
Phone (334) 699-5123

Other identifiers 2

IdentifierTypeStateIssuer
110221409OtherRAILROAD MEDICARE
051550636MedicaidAL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address anthony.spedale.1@20251.direct.athena.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100517000099 AL Practitioner - Internal Medicine 1052491594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in New Orleans, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3113 Wesley Way
Suite 1
Dothan, AL 36305-2004
Phone (334) 699-5123

Hospital & facility affiliations

  • Enhabit Home Health Home health agency, Dothan, AL, CCN 017053
  • Amedisys Home Health Home health agency, Dothan, AL, CCN 017159
  • Centerwell Home Health Home health agency, Dothan, AL, CCN 017164
  • Flowers Hospital Hospital, Dothan, AL, CCN 010055
  • Southeast Health Medical Center Hospital, Dothan, AL, CCN 010001
  • Troy Regional Medical Center Hospital, Troy, AL, CCN 010126
  • Dale Medical Center Hospital, Ozark, AL, CCN 010021

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22862ALMDPharmacist
24418LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Spedale MD PC CurrentSince Nov 1, 2019 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

3113 Wesley Way
Ste 1
Dothan, AL 36305
Phone (334) 699-5123

Interoperability endpoints

  • Direct secure messaging: anthony.spedale.1@20251.direct.athenahealth.com
  • Direct secure messaging: anthony.spedale.1@29417.direct.athenahealth.com

Organizations & group practices 2

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 7

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": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1699778662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3113 WESLEY WAY STE 1",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363052004",
            "telephone_number": "334-699-5123",
            "fax_number": "334-699-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 WESTSIDE DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031928",
            "telephone_number": "334-793-5074",
            "fax_number": "334-793-6460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPEDALE",
        "first_name": "ANTHONY",
        "middle_name": "ROLAND",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "24418",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "22862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110221409",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051550636",
            "state": "AL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "anthony.spedale.1@20251.direct.athena.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3113 Wesley Way Ste 1",
            "city": "Dothan",
            "state": "AL",
            "country_code": "US",
            "postal_code": "363052004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.