Active NPI
Kelly Lyles McMillian, M.D.
- Pediatrics Physician
- Birmingham, AL
National Provider Identifier
1760626113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 30655
- Practice address
- 101 Eagle Ridge Dr
Birmingham, AL 35242-5319 - Phone
- (205) 995-1004
- Fax
- (205) 991-6075
- NPI assigned
- Apr 29, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 30655 | AL | Primary |
Addresses
Primary practice location
101 Eagle Ridge Dr
Birmingham, AL 35242-5319
Mailing address
101 Eagle Ridge Dr
Birmingham, AL 35242-5319
Phone (205) 995-1004
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 511-23313 | Other | BCBS OF ALABAMA | |
| 000137515 | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30655 | AL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Children'S Hospital of Alabama | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Children's Hospital
- Birmingham, AL
- NPI 1205935012
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451865600000",
"number": "1760626113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 EAGLE RIDGE DR",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352425319",
"telephone_number": "205-995-1004",
"fax_number": "205-991-6075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 EAGLE RIDGE DR",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352425319",
"telephone_number": "205-995-1004",
"fax_number": "205-991-6075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCMILLIAN",
"first_name": "KELLY",
"middle_name": "LYLES",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-04-29",
"last_updated": "2016-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AL",
"license": "30655",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF ALABAMA",
"identifier": "511-23313",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000137515",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.