Prime Care Medical Center LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PRIME CARE MEDICAL CENTER LLC

Practice address

203 W Lee St
Tuskegee, AL 36083-1719

Phone

(334) 663-3587

Fax

(334) 821-6287

NPI assigned

Jun 9, 2013

Last updated

Jun 9, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Fazle Matin, MDNPI 1053452417

Title

Director

Phone

(334) 663-3587

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

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.

• Deanah Maxwell, MD

  • Family Medicine Physician
  • Brewton, AL
  • NPI 1124214770
  Medicare reassignment NPD
• Fazle Matin, MD

  • Pediatrics Physician
  • Tuskegee, AL
  • NPI 1053452417
  NPD (past) Authorized official

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

{
    "created_epoch": "1370736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370736000000",
    "number": "1821436155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2220 MT VERNON LN",
            "city": "AUBURN",
            "state": "AL",
            "postal_code": "368304257",
            "telephone_number": "334-821-6287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 W LEE ST",
            "city": "TUSKEGEE",
            "state": "AL",
            "postal_code": "360831719",
            "telephone_number": "334-663-3587",
            "fax_number": "334-821-6287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME CARE MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-09",
        "last_updated": "2013-06-09",
        "status": "A",
        "authorized_official_last_name": "MATIN",
        "authorized_official_first_name": "FAZLE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "334-663-3587",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashika Person
• Karen J Peterson, LGSW
• Ashantia M Pittman, LMSW
• Carlton Dale Posey, PH.D.
• Desha Price
• Carrietta Pritchett-Stallworth, LGSW
• Serena Promisee, LCSW
• Lela Denese Pugh, LCSW
• Amelia Shanell Purifoy, LICSW
• Quality of Life Health Services Inc (Tuskegee Quality Pharmacy)

• Primary Care Clinic/Center in Tuskegee, AL
• Providers in Tuskegee, AL by specialty
• Primary Care Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.