Individual provider Active NPI

Kenneth R. Rettig, MD

  • Pediatric Endocrinology Physician
  • Mobile, AL
National Provider Identifier
1861431587
Registry record updated Mar 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X
License
9210 Issued in AL
Practice address
1601 Center Street
Ste 1S
Mobile, AL 36604-3207
Phone
(251) 410-5437
Fax
(251) 434-3852
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Endocrinology Physician 2080P0205X 9210 AL Primary

Addresses

Primary practice location

1601 Center Street
Ste 1S
Mobile, AL 36604-3207

Mailing address

PO Box 40480
Mobile, AL 36640-0480
Phone (251) 410-5437

Other identifiers 6

IdentifierTypeStateIssuer
255656100MedicaidFL
33-10016OtherALUNITED HEALTH CARE
1722634MedicaidLA
000015487MedicaidAL
00015345MedicaidMS
51015487OtherALBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9210ALMDPediatric Endocrinology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
USA Health Physician Billing Services LLC CurrentSince Oct 1, 2019 Accepting new patients
USA Health Physician Billing Services LLC CurrentSince Oct 1, 2019 Accepting new patients
University of South Alabama CurrentSince Jul 1, 2016 Accepting new patients
USA Health - Mci Business Services LLC Current Accepting new patients
University of South Alabama Current Accepting new patients
University of South Alabama CurrentSince Jul 1, 2016 Accepting new patients
USA Health Physician Billing Services LLC Current Accepting new patients

Locations

1601 Center St
Ste 1S
Mobile, AL 36604
Phone (251) 410-5437

2451 Fillingim St
Mobile, AL 36617
Phone (251) 434-3711

75 S University Blvd
Unit 6000
Mobile, AL 36608
Phone (251) 660-5555

1660 Spring Hill Ave
Mobile, AL 36604
Phone (251) 445-9616

75 S University Blvd
Unit 6500
Mobile, AL 36608
Phone (251) 445-8282

1660 Spring Hill Ave
Ste 3069
Mobile, AL 36604
Phone (251) 445-8405

1601 Center St
Mobile, AL 36604
Phone (251) 410-5437

1707 Center St
Ste 102
Mobile, AL 36604

Networks

  • bcbs alabama network 01A0
  • bcbs alabama network 01H0
  • bcbs alabama network 01B0
  • bcbs alabama network 01G0
  • bcbs alabama network 01E0

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488412800000",
    "number": "1861431587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40480",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366400480",
            "telephone_number": "251-410-5437",
            "fax_number": "251-434-3852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 CENTER STREET",
            "address_2": "STE 1S",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366043207",
            "telephone_number": "251-410-5437",
            "fax_number": "251-434-3852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETTIG",
        "first_name": "KENNETH",
        "middle_name": "R.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2017-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "AL",
            "license": "9210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255656100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "33-10016",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1722634",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000015487",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00015345",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "51015487",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

Verify at the official NPI Registry.