Individual provider Active NPI

Peter De Mola, MD

  • Internal Medicine Physician
  • Dothan, AL
National Provider Identifier
1700402807
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD.46876 Issued in AL
Practice address
1108 Ross Clark Cir
Dothan, AL 36301-3022
Phone
(334) 712-3635
NPI assigned
Jun 24, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD.46876 AL Primary

Addresses

Primary practice location

1108 Ross Clark Cir
Dothan, AL 36301-3022

Mailing address

99 Birwoode Dr
Pontiac, MI 48340-2257
Phone (323) 337-4845

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
I20231019003263 AL Practitioner - Internal Medicine 4688099278 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Houston County Healthcare AuthorityGroup PAC ID 9436062296, 256 clinicians

Practice addresses (Care Compare)

1108 Ross Clark Cir
Dothan, AL 36301-3022
Phone (334) 793-8087

Hospital & facility affiliations

  • Southeast Health Medical Center Hospital, Dothan, AL, CCN 010001

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Laboratory Associates Current Accepting new patients
Houston County Healthcare Authority Internal Medicine CurrentSince Sep 6, 2023 Accepting new patients
Medcore Associates, PLLC Current Accepting new patients
Houston County Healthcare Authority Internal Medicine Current Accepting new patients
Houston County Healthcare Authority Internal Medicine Current Accepting new patients
Houston County Healthcare Authority Past Accepting new patients

Locations

1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635

Organizations & group practices 6

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": "1592956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1700402807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 BIRWOODE DR",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483402257",
            "telephone_number": "323-337-4845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 ROSS CLARK CIR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013022",
            "telephone_number": "334-712-3635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE MOLA",
        "first_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-24",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "MD.46876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.