Individual provider Active NPI

Ada Myriam Peralta-Carcelen, M.D.

  • Pediatrics Physician
  • Birmingham, AL
National Provider Identifier
1760409874
Registry record updated Jan 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
15068 Issued in AL
Practice address
1616 6TH Ave S
Birmingham, AL 35233-1788
Phone
(205) 939-9096
Fax
(205) 975-6503
NPI assigned
Jul 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 15068 AL Primary

Addresses

Primary practice location

1616 6TH Ave S
Birmingham, AL 35233-1788

Mailing address

703 Volker Hall
Birmingham, AL 35294-0001
Phone (205) 934-3795

Other identifiers 6

IdentifierTypeStateIssuer
000083222MedicaidAL
1210029OtherUHC
000028826MedicaidAL
009999655MedicaidAL
510-83222OtherALBC BS
E40209OtherVIVA

Other names 1

  • Myriam Peralta Other name

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
I20160926000536 AL Practitioner - Pediatric Medicine 0648567214 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15068ALMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Alabama Health Services Foundation, PC. CurrentSince Aug 20, 2016 Accepting new patients
University of Alabama Health Services Foundation, PC Pediatrics CurrentSince Aug 20, 2016 Accepting new patients
Uahsf PC Department of Peds Hemoc Pediatrics Past Accepting new patients

Locations

1600 7th Ave S
Birmingham, AL 35233
Phone (205) 638-9100

1616 6th Ave S
Birmingham, AL 35233
Phone (205) 939-9096

703 Volker Hall
Birmingham, AL 35294
Phone (205) 638-9587

Interoperability endpoints

  • Direct secure messaging: aperaltacarcelen21907@childrensofalabama.direct-ci.com
  • Direct secure messaging: mperalta@direct.uabmedicine.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294963200000",
    "number": "1760409874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 VOLKER HALL",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352940001",
            "telephone_number": "205-934-3795",
            "fax_number": "205-975-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 6TH AVE S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352331788",
            "telephone_number": "205-939-9096",
            "fax_number": "205-975-6503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERALTA-CARCELEN",
        "first_name": "ADA",
        "middle_name": "MYRIAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-16",
        "last_updated": "2011-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "15068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000083222",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "1210029",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000028826",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009999655",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "510-83222",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIVA",
            "identifier": "E40209",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MYRIAM",
            "last_name": "PERALTA",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Birmingham, AL

Sources for this page

Verify at the official NPI Registry.