Lautrec Wilson Radcliff, MD

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

14179 Issued in AL

Practice address

2609 Village Professional Dr
Suite 3
Opelika, AL 36801-5442

Phone

(334) 749-6523

Fax

(334) 742-0242

NPI assigned

Jul 30, 2006

Last updated

Sep 13, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 9

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hypertension & Nephrology

  • Nephrology Physician
  • Opelika, AL
  • NPI 1134289580
  Medicare reassignment

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315872000000",
    "number": "1801801493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2609 VILLAGE PROFESSIONAL DR",
            "address_2": "SUITE 3",
            "city": "OPELIKA",
            "state": "AL",
            "postal_code": "368015442",
            "telephone_number": "334-749-6523",
            "fax_number": "334-742-0242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2609 VILLAGE PROFESSIONAL DR",
            "address_2": "SUITE 3",
            "city": "OPELIKA",
            "state": "AL",
            "postal_code": "368015442",
            "telephone_number": "334-749-6523",
            "fax_number": "334-742-0242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADCLIFF",
        "first_name": "LAUTREC",
        "middle_name": "WILSON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-30",
        "last_updated": "2011-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "14179",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AL",
            "license": "14179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS AUBURN",
            "identifier": "51520919",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1801801493",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS LAFAYETTE",
            "identifier": "51038111",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS DADEVILLE",
            "identifier": "51079111",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TUSKEGEE",
            "identifier": "51079203",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "CC1726",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS LANGDALE",
            "identifier": "51079130",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OPELIKA",
            "identifier": "51079131",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528701590",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Pugh
• Joshua Nathaniel Pumroy, DO
• P. George Purves, MD
• Kori Ashlyn Quillin
• Andrew Jacob Quinton, CRNP
• Theodore Rader
• Laura Elise Rainey, LICSW-S
• Emily Tara Rajan
• Rishi R Rajan, M.D.
• Bronwyn Deck Ramsey, LPC

• Nephrology Physician in Opelika, AL
• Providers in Opelika, AL by specialty
• Nephrology Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.