NPIMap

Organization Active NPI

Medical East of Decatur Inc

Doing business as Somerville Family Medicine

  • Family Nurse Practitioner
  • Somerville, AL
National Provider Identifier
1700238508
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
MEDICAL EAST OF DECATUR INC
Doing business as
Somerville Family Medicine
Practice address
4166 Highway 36 E
Somerville, AL 35670-5803
Phone
(256) 778-7172
Fax
(256) 778-8910
NPI assigned
Jul 6, 2016
Last updated
May 22, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDICAL EAST OF DECATUR INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 22, 2025

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

Authorized official

Name
Michelle D Graham
Title
Clinical Director
Phone
(256) 432-2822

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

4166 Highway 36 E
Somerville, AL 35670-5803

Mailing address

2941 Point Mallard Pkwy SE
Decatur, AL 35603-5716
Phone (256) 432-2822

Other names 1

  • Somerville Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161129000873 AL Part A Provider - Rural Health Clinic 4688731409 Practice locations: Somerville, AL
O20220304001983 AL Part B Supplier - Clinic/Group Practice 4688731409 Receives reassigned benefits from 5 practitioners
Practice locations: Somerville, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700238508. Details of each certification follow.

Rural health clinic certification: CCN 018927

Legal name
MEDICAL EAST OF DECATUR INC
Doing business as
SOMERVILLE FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 13, 2017
Last certification
Jan 4, 2024
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Dec 22, 2008 in AL
Enrollment address
4166 Highway 36 E
Somerville, AL 35670-5803

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Medical East of Decatur Inc

Locations

2941 Point Mallard Pkwy SE
Decatur, AL 35603
Phone (256) 432-2822

2941 Point Mallard Pkwy SE
Ste N
Decatur, AL 35603
Phone (256) 432-2822

4166 Highway 36 E
Somerville, AL 35670
Phone (256) 432-2822

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
Kim L Harbin Individual 5% Or Greater Direct Ownership Interest Dec 22, 2008 100%
Corporate DirectorPresident Dec 22, 2008 100%
W-2 Managing EmployeePresident Dec 22, 2008 100%
Operational/Managerial ControlPresident Dec 22, 2008 100%
Michelle Sloan Graham Individual W-2 Managing EmployeeClinical Director Jul 1, 2015 100%
Operational/Managerial ControlClinical Director Jul 1, 2015 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747872000000",
    "number": "1700238508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2941 POINT MALLARD PKWY SE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356035716",
            "telephone_number": "256-432-2822",
            "fax_number": "256-432-2825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4166 HIGHWAY 36 E",
            "city": "SOMERVILLE",
            "state": "AL",
            "postal_code": "356705803",
            "telephone_number": "256-778-7172",
            "fax_number": "256-778-8910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL EAST OF DECATUR INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL EAST OF DECATUR INC",
        "enumeration_date": "2016-07-06",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "256-432-2822"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Somerville Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Somerville, AL

Sources for this page

Verify at the official NPI Registry.