NPIMap

Individual provider Active NPI

Austin Wyatt Bivins, CRNP

  • Acute Care Nurse Practitioner
  • Dothan, AL
National Provider Identifier
1720646102
Registry record updated May 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
1-151891 Issued in AL
Practice address
4370 W Main St
Dothan, AL 36305-4000
Phone
(334) 793-5000
NPI assigned
May 31, 2019
Last updated
May 31, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 1-151891 AL Primary

Addresses

Primary practice location

4370 W Main St
Dothan, AL 36305-4000

Mailing address

413 Burt Dr Apt 7
Dothan, AL 36305-1161
Phone (317) 735-5567

Other practice location 1

413 Burt Dr Apt 7
Dothan, AL 36305-1161
Phone (317) 735-5567

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
I20190624003511 AL Practitioner - Nurse Practitioner 5890029920 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Alabama College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
S.B.J.S. PCGroup PAC ID 8527043421, 39 clinicians

Practice addresses (Care Compare)

1500 Ross Clark Cir
Dothan, AL 36301-4754
Phone (334) 793-2663

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
45.86 of 100Reported as group
Quality
6.09
Improvement activities
40
Cost
81.25

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1-151891ALMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
SBJS PC CurrentSince Feb 1, 2021 Accepting new patients
Rural Urgent Care LLC CurrentSince Apr 6, 2020 Accepting new patients
Rural Urgent Care LLC CurrentSince Apr 6, 2020 Accepting new patients
S.B.J.S. PC CurrentSince Feb 1, 2021 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
S.B.J.S. PC Past Accepting new patients

Locations

508 E Three Notch St
Ste 100
Andalusia, AL 36420
Phone (334) 362-2015

1925 W Main St
#120
Centre, AL 35960
Phone (256) 677-4552

1500 Ross Clark Cir
Dothan, AL 36301
Phone (334) 793-2663

345 Healthwest Dr
Dothan, AL 36303
Phone (334) 793-2663

1026 S Eufaula Ave
Eufaula, AL 36027
Phone (334) 687-5775

Interoperability endpoints

  • Direct secure messaging: austin.bivins.1@15455.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1559260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559260800000",
    "number": "1720646102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 BURT DR APT 7",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051161",
            "telephone_number": "317-735-5567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4370 W MAIN ST",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363054000",
            "telephone_number": "334-793-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "413 Burt Dr Apt 7",
            "address_purpose": "LOCATION",
            "city": "Dothan",
            "state": "AL",
            "postal_code": "363051161",
            "country_code": "US",
            "telephone_number": "317-735-5567",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BIVINS",
        "first_name": "AUSTIN",
        "middle_name": "WYATT",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-31",
        "last_updated": "2019-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AL",
            "license": "1-151891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.