NPIMap

Organization Active NPI

Professional Resource Managment of Wiregrass, LLC

  • Psychiatry Physician
  • Ozark, AL
National Provider Identifier
1740358837
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
PROFESSIONAL RESOURCE MANAGMENT OF WIREGRASS, LLC
Practice address
1970 Andrews Ave
Ozark, AL 36360-3726
Phone
(334) 774-1555
NPI assigned
Nov 30, 2006
Last updated
Dec 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Authorized official

Name
Nancy A Gilley
Title
Authorized Official
Phone
(334) 712-1170

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

1970 Andrews Ave
Ozark, AL 36360-3726

Mailing address

2812 Hartford Hwy Ste 1
Dothan, AL 36305-4927
Phone (334) 712-1170

Other identifiers 2

IdentifierTypeStateIssuer
529923390MedicaidAL
K365OtherALMEDICARE GROUP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050428001294 AL Part B Supplier - Clinic/Group Practice 5698714525 Receives reassigned benefits from 14 practitioners
3 other NPIs on this enrollment
Practice locations: Dothan, AL; Ozark, AL

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2812 Hartford Hwy
Dothan, AL 36305
Phone (334) 350-3162

212 Hospital Ave
#F
Ozark, AL 36360

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1740358837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2812 HARTFORD HWY STE 1",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363054927",
            "telephone_number": "334-712-1170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 ANDREWS AVE",
            "city": "OZARK",
            "state": "AL",
            "postal_code": "363603726",
            "telephone_number": "334-774-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL RESOURCE MANAGMENT OF WIREGRASS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "GILLEY",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "334-712-1170"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529923390",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "K365",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ozark, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; 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.