Active NPI
Robert P Nuttall, MD
- Pediatric Radiology Physician
- Birmingham, AL
National Provider Identifier
1891790168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Radiology Physician
- License
- 00014815
- Practice address
- 1600 7TH Ave S
Birmingham, AL 35233-1711 - Phone
- (205) 939-9665
- NPI assigned
- Jun 14, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Radiology Physician | 2085P0229X | 00014815 | AL | Primary |
Addresses
Primary practice location
1600 7TH Ave S
Birmingham, AL 35233-1711
Mailing address
2000A Southbridge Pkwy
Ste 300
Birmingham, AL 35209-7718
Phone (205) 871-4274
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104069 | Medicaid | AL | |
| 511-61184 | Other | AL | BLUE CROSS |
| 051516677 | Other | AL | BCBS AL (UAB) |
| 515-16677 | Other | AL | BLUE CROSS |
| P00107083 | Other | AL | RAILROAD MEDICARE UAB |
| 630842160 | Other | AL | AETNA |
| 009927295 | Medicaid | AL | |
| 103559 | Medicaid | AL | |
| 515-90119 | Other | AL | BLUE CROSS |
| 009925705 | Medicaid | AL | |
| 009958825 | Medicaid | AL | |
| 515-20581 | Other | AL | BLUE CROSS |
| 009993575 | Medicaid | AL | |
| 515-17616 | Other | AL | BLUE CROSS |
| 515-17618 | Other | AL | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00014815 | AL | MD | Pediatric Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brookwood Diagnostic Imaging Center, LLC | Past | Accepting new patients | |
| Southlake Orthopaedics Sports Medicine and Spine Center, PC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Radiology Clinic/Center
- Birmingham, AL
- NPI 1538520721
-
dba Southlake Prosthetics and Orthotics
- Prosthetic/Orthotic Supplier
- Hoover, AL
- NPI 1780281741
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451433600000",
"number": "1891790168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000A SOUTHBRIDGE PKWY",
"address_2": "STE 300",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352097718",
"telephone_number": "205-871-4274",
"fax_number": "205-871-4301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 7TH AVE S",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352331711",
"telephone_number": "205-939-9665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUTTALL",
"first_name": "ROBERT",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-14",
"last_updated": "2015-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "2085P0229X",
"taxonomy_group": "",
"desc": "Radiology, Pediatric Radiology",
"state": "AL",
"license": "00014815",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104069",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "511-61184",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS AL (UAB)",
"identifier": "051516677",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "515-16677",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE UAB",
"identifier": "P00107083",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "630842160",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009927295",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103559",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "515-90119",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009925705",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009958825",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "515-20581",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009993575",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "515-17616",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "515-17618",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.