NPIMap

Organization Active NPI

Bama Pedicatrics LLC

  • Pediatrics Physician
  • Northport, AL
National Provider Identifier
1720137334
Registry record updated Sep 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
22399 Issued in AL
Legal business name
BAMA PEDICATRICS LLC
Practice address
920 Rose Drive
Northport, AL 35476
Phone
(205) 333-5900
Fax
(205) 333-6090
NPI assigned
Jan 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2009

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

Authorized official

Name
Bindu Bennuri, MDNPI 1063511202
Title
Provider
Phone
(205) 333-5900

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207K00000X 22564 AL
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 22399 AL Primary

Addresses

Primary practice location

920 Rose Drive
Northport, AL 35476

Mailing address

920 Rose Drive
Northport, AL 35476
Phone (205) 333-5900

Other identifiers 1

IdentifierTypeStateIssuer
529921850MedicaidAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050204000558 AL Part B Supplier - Clinic/Group Practice 0244281459 Receives reassigned benefits from 2 practitioners
Practice locations: Northport, AL

National Provider Directory

National Provider Directory

Locations

920 Rose Dr
Northport, AL 35476
Phone (205) 333-5900

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253664000000",
    "number": "1720137334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 ROSE DRIVE",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "35476",
            "telephone_number": "205-333-5900",
            "fax_number": "205-333-6090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 ROSE DRIVE",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "35476",
            "telephone_number": "205-333-5900",
            "fax_number": "205-333-6090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAMA PEDICATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2009-09-23",
        "status": "A",
        "authorized_official_last_name": "BENNURI",
        "authorized_official_first_name": "BINDU",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "205-333-5900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": "AL",
            "license": "22564",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "22399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529921850",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northport, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.