NPIMap

Organization Active NPI

DCH Provider Services, LLC

Doing business as Fayette Medical Center Hospitalists

  • Hospitalist Physician
  • Fayette, AL
National Provider Identifier
1841421757
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
DCH PROVIDER SERVICES, LLC
Doing business as
Fayette Medical Center Hospitalists
Practice address
1653 Temple Ave N
Fayette, AL 35555-1314
Phone
(205) 932-1280
Fax
(205) 932-1260
NPI assigned
Jul 28, 2009
Last updated
Jan 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

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

Authorized official

Name
Daniel Clay Conville
Title
Director, Physician Services
Phone
(205) 759-6165

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU
Hospitalist Physician 208M00000X NU Primary

Addresses

Primary practice location

1653 Temple Ave N
Fayette, AL 35555-1314

Mailing address

1110 Dr Edward Hillard Dr Ste a
Tuscaloosa, AL 35401-7446
Phone (205) 333-4661

Other identifiers 3

IdentifierTypeStateIssuer
113147MedicaidAL
1841421757OtherALGROUP NPI
DA1832OtherMEDICARE RAILROAD

Other names 1

  • Fayette Medical Center Hospitalists Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031210000253 AL Part B Supplier - Clinic/Group Practice 9234035346 Receives reassigned benefits from 24 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fayette, AL
O20180504001564 AL Part B Supplier - Clinic/Group Practice 6800150517 Receives reassigned benefits from 86 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fayette, AL; Northport, AL; Tuscaloosa, AL

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
DCH Pediatric Hospitalists5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1716 Temple Ave N
Ste 12
Fayette, AL 35555
Phone (205) 932-5966

Practitioners & affiliated clinicians

Practitioners 34

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.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610496000000",
    "number": "1841421757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 DR EDWARD HILLARD DR STE A",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354017446",
            "telephone_number": "205-333-4661",
            "fax_number": "205-333-4660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1653 TEMPLE AVE N",
            "city": "FAYETTE",
            "state": "AL",
            "postal_code": "355551314",
            "telephone_number": "205-932-1280",
            "fax_number": "205-932-1260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DCH PROVIDER SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-28",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A",
        "authorized_official_last_name": "CONVILLE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "CLAY",
        "authorized_official_title_or_position": "DIRECTOR, PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "205-759-6165"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113147",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1841421757",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DA1832",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fayette Medical Center Hospitalists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayette, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; 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.