NPIMap

Organization Active NPI

Clanton Internal Medicine LLC

  • Internal Medicine Physician
  • Clanton, AL
National Provider Identifier
1821029240
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
16833 Issued in AL
Legal business name
CLANTON INTERNAL MEDICINE LLC
Practice address
1008 Lay Dam Rd
Clanton, AL 35045-2306
Phone
(205) 755-3500
Fax
(205) 280-3348
NPI assigned
Jul 5, 2006
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
Mrs. Evelyn Cook
Title
Office Manager
Phone
(205) 755-3500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 16833 AL Primary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 20673 AL

Addresses

Primary practice location

1008 Lay Dam Rd
Clanton, AL 35045-2306

Mailing address

1008 Lay Dam Rd
Clanton, AL 35045-2306
Phone (205) 755-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051104000790 AL Part B Supplier - Clinic/Group Practice 0446278774 Receives reassigned benefits from 3 practitioners
Practice locations: Clanton, AL

National Provider Directory

National Provider Directory

Locations

1320 Woodfin Ln
Clanton, AL 35045
Phone (205) 755-3500

1008 Lay Dam Rd
Clanton, AL 35045
Phone (205) 755-3500

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821029240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 LAY DAM RD",
            "city": "CLANTON",
            "state": "AL",
            "postal_code": "350452306",
            "telephone_number": "205-755-3500",
            "fax_number": "205-280-3348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 LAY DAM RD",
            "city": "CLANTON",
            "state": "AL",
            "postal_code": "350452306",
            "telephone_number": "205-755-3500",
            "fax_number": "205-280-3348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLANTON INTERNAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "205-755-3500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "16833",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "20673",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clanton, 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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.