NPIMap

Organization Active NPI

Providence Hospital

  • Hospitalist Physician
  • Mobile, AL
National Provider Identifier
1871922971
Registry record updated Sep 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
PROVIDENCE HOSPITAL
Practice address
6801 Airport Blvd
Hospitalist Dept.
Mobile, AL 36608-3709
Phone
(251) 639-5775
Fax
(251) 631-3581
NPI assigned
Nov 8, 2013
Last updated
Sep 28, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2015

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

Authorized official

Name
Mr. Todd S. Kennedy
Title
President
Phone
(251) 633-1660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208M00000X Primary

Addresses

Primary practice location

6801 Airport Blvd
Hospitalist Dept.
Mobile, AL 36608-3709

Mailing address

PO Box 850489
Mobile, AL 36685-0489
Phone (251) 342-3949

Other names 1

  • Hospitalist Group Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051219000880 AL Part B Supplier - Clinic/Group Practice 9830111871 Receives reassigned benefits from 161 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mobile, AL

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Providence Hosp Emer3 organizations share this tax ID, including this one
Part of
Providence Hosp Emer

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 72

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 72

NPI Registry JSON

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

{
    "created_epoch": "1383868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443398400000",
    "number": "1871922971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850489",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366850489",
            "telephone_number": "251-342-3949",
            "fax_number": "251-631-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 AIRPORT BLVD",
            "address_2": "HOSPITALIST DEPT.",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366083709",
            "telephone_number": "251-639-5775",
            "fax_number": "251-631-3581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HOSPITAL",
        "enumeration_date": "2013-11-08",
        "last_updated": "2015-09-28",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "251-633-1660",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospitalist Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; 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.