NPIMap

Organization Active NPI

Madison Primary Care LLC

Doing business as Madison Primary Care

  • Family Medicine Physician
  • Madison, AL
National Provider Identifier
1881993210
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MADISON PRIMARY CARE LLC
Doing business as
Madison Primary Care
Practice address
400 Sun Temple Dr
Madison, AL 35758-5924
Phone
(256) 774-5524
Fax
(256) 774-5523
NPI assigned
Mar 24, 2011
Last updated
Aug 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Authorized official

Name
Mr. Adeel Bodla, M.D.NPI 1679770267
Title
Physician
Phone
(626) 644-7722

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

400 Sun Temple Dr
Madison, AL 35758-5924

Mailing address

400 Sun Temple Dr
Madison, AL 35758-5924
Phone (256) 774-5524

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidAL

Other names 1

  • MADISON PRIMARY CARE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110412000068 AL Part B Supplier - Clinic/Group Practice 0042494346 Receives reassigned benefits from 9 practitioners
Practice locations: Madison, AL

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2021281Madison Primary Care LLC400 Sun Temple Dr, Madison, AL 35758Certificate of waiverMar 9, 2027

National Provider Directory

National Provider Directory

Locations

400 Sun Temple Dr
Madison, AL 35758
Phone (256) 774-5524

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12216/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1300924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1881993210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 SUN TEMPLE DR",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357585924",
            "telephone_number": "256-774-5524",
            "fax_number": "256-774-5523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SUN TEMPLE DR",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357585924",
            "telephone_number": "256-774-5524",
            "fax_number": "256-774-5523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-24",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A",
        "authorized_official_last_name": "BODLA",
        "authorized_official_first_name": "ADEEL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "626-644-7722",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MADISON PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MADISON PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; 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.