Individual provider Active NPI

Lasondra Coley, CRNP

  • Gerontology Nurse Practitioner
  • Tuscaloosa, AL
National Provider Identifier
1811368392
Registry record updated Oct 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
1116620 Issued in AL
Practice address
931 Fairfax Park
Tuscaloosa, AL 35406-2805
Phone
(205) 343-7300
Fax
(205) 722-5335
NPI assigned
Oct 9, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 1116620 AL Primary

Addresses

Primary practice location

931 Fairfax Park
Tuscaloosa, AL 35406-2805

Mailing address

931 Fairfax Park
Tuscaloosa, AL 35406-2805
Phone (205) 343-7300

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151012002484 AL Practitioner - Nurse Practitioner 0648589796 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Russellville Hospital Inc.Group PAC ID 3476878489, shared by 6 NPIs, 66 clinicians

Practice addresses (Care Compare)

13150 Hwy 43
Suite 10
Russellville, AL 35653-4566
Phone (256) 332-5901

Hospital & facility affiliations

  • Amedisys Home Health Lakeshore of Birmingham Home health agency, Homewood, AL, CCN 017051

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1116620ALMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Eastern Hospital Medicine PC CurrentSince Aug 7, 2017 Accepting new patients
Eastern Hospital Medicine PC CurrentSince Aug 7, 2017 Accepting new patients

Locations

50 Medical Park Dr E
Birmingham, AL 35235
Phone (205) 838-3000

4941 Montevallo Rd
Irondale, AL 35210
Phone (205) 956-1831

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1444348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444348800000",
    "number": "1811368392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 FAIRFAX PARK",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354062805",
            "telephone_number": "205-343-7300",
            "fax_number": "205-722-5335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 FAIRFAX PARK",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354062805",
            "telephone_number": "205-343-7300",
            "fax_number": "205-722-5335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEY",
        "first_name": "LASONDRA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-09",
        "last_updated": "2015-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AL",
            "license": "1116620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuscaloosa, AL

Sources for this page

Verify at the official NPI Registry.