NPIMap

Organization Active NPI

Fagan LLC

  • Specialist
  • Birmingham, AL
National Provider Identifier
1770740482
Registry record updated Jan 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
14105 Issued in AL
Legal business name
FAGAN LLC
Practice address
3125 Independence Dr
Suite 300a
Birmingham, AL 35209-4159
Phone
(205) 879-8206
Fax
(205) 879-0675
NPI assigned
May 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2011

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

Authorized official

Name
Dr. Kimberly M Fagan, M.D.
Title
Doctor/Owner
Phone
(205) 879-8206

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 14105 AL Primary
Durable Medical Equipment & Medical Supplies 332B00000X 14105 AL
Prosthetic/Orthotic Supplier 335E00000X 14105 AL

Addresses

Primary practice location

3125 Independence Dr
Suite 300a
Birmingham, AL 35209-4159

Mailing address

3125 Independence Dr
Suite 300a
Birmingham, AL 35209-4159
Phone (205) 879-8206

Other identifiers 1

IdentifierTypeStateIssuer
I621OtherALMEDICARE GROUP IDENTIFIER

Other names 1

  • Fagan Sports Medicine Doing business as

National Provider Directory

National Provider Directory

Locations

880 Montclair Rd
Ste 577
Birmingham, AL 35213
Phone (205) 595-6757

3125 Independence Dr
Ste 300A
Homewood, AL 35209
Phone (205) 263-9775

3125 Independence Dr
Ste 300
Homewood, AL 35209
Phone (205) 879-8206

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294272000000",
    "number": "1770740482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3125 INDEPENDENCE DR",
            "address_2": "SUITE 300A",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352094159",
            "telephone_number": "205-879-8206",
            "fax_number": "205-879-0675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3125 INDEPENDENCE DR",
            "address_2": "SUITE 300A",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352094159",
            "telephone_number": "205-879-8206",
            "fax_number": "205-879-0675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAGAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2011-01-06",
        "status": "A",
        "authorized_official_last_name": "FAGAN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "205-879-8206",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AL",
            "license": "14105",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AL",
            "license": "14105",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "AL",
            "license": "14105",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP IDENTIFIER",
            "identifier": "I621",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fagan Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.