NPIMap

Organization Active NPI

Boaz Family Medicine, PC

  • Clinic/Center
  • Boaz, AL
National Provider Identifier
1790840775
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
DO287 Issued in AL
Legal business name
BOAZ FAMILY MEDICINE, PC
Practice address
122 N Snead St
Boaz, AL 35957-1763
Phone
(256) 840-5800
Fax
(256) 840-5600
NPI assigned
Dec 27, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jerry Russell Robinson, D. O.
Title
Physician
Phone
(256) 840-5800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X DO287 AL Primary

Addresses

Primary practice location

122 N Snead St
Boaz, AL 35957-1763

Mailing address

122 N Snead St
Boaz, AL 35957-1763
Phone (256) 840-5800

Other identifiers 1

IdentifierTypeStateIssuer
51504831OtherALBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790840775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 N SNEAD ST",
            "city": "BOAZ",
            "state": "AL",
            "postal_code": "359571763",
            "telephone_number": "256-840-5800",
            "fax_number": "256-840-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 N SNEAD ST",
            "city": "BOAZ",
            "state": "AL",
            "postal_code": "359571763",
            "telephone_number": "256-840-5800",
            "fax_number": "256-840-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOAZ FAMILY MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "256-840-5800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D. O."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AL",
            "license": "DO287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51504831",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boaz, AL

Sources for this page

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