Individual provider Active NPI

Kellen Allaman Spivey, D.M.D.

  • General Practice Dentistry
  • Anniston, AL
National Provider Identifier
1801025267
Registry record updated Jul 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5704 Issued in AL
Practice address
6118 McClellan Blvd
Anniston, AL 36206-8403
Phone
(256) 820-4821
Fax
(256) 820-2219
NPI assigned
Jul 7, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5704 AL Primary

Addresses

Primary practice location

6118 McClellan Blvd
Anniston, AL 36206-8403

Mailing address

6118 McClellan Blvd
Anniston, AL 36206-8403
Phone (256) 820-4821

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150421000784 AL Practitioner - Oral Surgery 3173841293 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5704ALMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Kellen a. Spivey Dental Services, LLC General Practice CurrentSince Feb 26, 2015 Accepting new patients

Locations

6118 McClellan Blvd
Anniston, AL 36206
Phone (256) 820-4821

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.

NPI Registry JSON

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

{
    "created_epoch": "1246924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246924800000",
    "number": "1801025267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6118 MCCLELLAN BLVD",
            "city": "ANNISTON",
            "state": "AL",
            "postal_code": "362068403",
            "telephone_number": "256-820-4821",
            "fax_number": "256-820-2219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6118 MCCLELLAN BLVD",
            "city": "ANNISTON",
            "state": "AL",
            "postal_code": "362068403",
            "telephone_number": "256-820-4821",
            "fax_number": "256-820-2219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPIVEY",
        "first_name": "KELLEN",
        "middle_name": "ALLAMAN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-07",
        "last_updated": "2009-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "5704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anniston, AL

Sources for this page

Verify at the official NPI Registry.