NPIMap

Organization Active NPI

Southeast Alabama Rural Health Associates

Doing business as Enterprise Children's Center & Family Medicine

  • Federally Qualified Health Center (FQHC)
  • Enterprise, AL
National Provider Identifier
1891856134
Registry record updated Feb 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES
Doing business as
Enterprise Children's Center & Family Medicine
Practice address
105 E Watts St
Enterprise, AL 36330-2511
Phone
(334) 393-5437
Fax
(334) 489-4438
NPI assigned
Dec 12, 2006
Last updated
Feb 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2019

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

Authorized official

Name
John A Little, MPH
Title
Ceo
Phone
(334) 670-6726

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

105 E Watts St
Enterprise, AL 36330-2511

Mailing address

1414 Elba Hwy
Troy, AL 36079-6020
Phone (334) 670-6726

Other identifiers 1

IdentifierTypeStateIssuer
630006018MedicaidAL

Other names 1

  • Enterprise Children's Center & Family Medicine Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040526001591 AL Part B Supplier - Clinic/Group Practice 8123009057 Receives reassigned benefits from 32 practitioners
11 other NPIs on this enrollment
Practice locations: Troy, AL; Slocomb, AL; Newton, AL; Geneva, AL; Eufaula, AL; Enterprise, AL; Dothan, AL; Clayton, AL…
O20121024000349 AL Part A Provider - Federally Qualified Health Center (FQHC) 4789625948 Practice locations: Enterprise, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891856134. Details of each certification follow.

Federally qualified health center certification: CCN 011002

Legal name
SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES
Doing business as
ENTERPRISE CHILDREN'S CENTER & FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 24, 2012
Last certification
Oct 24, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1983 in AL
Enrollment address
105 E Watts St
Enterprise, AL 36330-2511

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 11

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

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
01D0879457Enterprise Children's Center and Family Medicine105 E Watts Steeet, Enterprise, AL 36330AccreditationJul 29, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Oveta Carey Individual Corporate Director Jun 22, 2021
Cynthia Pearson Individual Corporate OfficerBoard Member Sep 24, 2012
Corporate DirectorBoard Member Sep 24, 2012
OtherBoard Member Sep 24, 2012
Hank Strother Individual Corporate Director Jun 22, 2021
Regina Tolbert Individual Corporate Director Jun 22, 2021
Lisa Harris Individual Corporate Director Jun 22, 2021
Leticia Andrews Individual Corporate OfficerBoard Member Sep 24, 2012
Corporate DirectorBoard Member Sep 24, 2012
OtherBoard Member Sep 24, 2012
Joe Dalton Individual Corporate OfficerBoard Member Sep 24, 2012
Corporate DirectorBoard Member Sep 24, 2012
OtherBoard Member Sep 24, 2012
Pamylon Bowers Individual Corporate DirectorCeo Jun 22, 2021 100%
W-2 Managing EmployeeCeo Jun 22, 2021 100%
Jack Worthington Individual Corporate Director Jun 22, 2021

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Slocomb Family Health CenterSlocomb, AL, CCN 011955 Federally qualified health center Operational/Managerial Control (100%) Jul 25, 2011
Clayton Family Health CenterClayton, AL, CCN 011868 Federally qualified health center Operational/Managerial Control Sep 17, 2025
Abbeville Family Health CenterAbbeville, AL, CCN 011975 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2011
Dothan Family Health CenterDothan, AL, CCN 011808 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2012
Geneva Family Health CenterGeneva, AL, CCN 011088 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2021

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550707200000",
    "number": "1891856134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 ELBA HWY",
            "city": "TROY",
            "state": "AL",
            "postal_code": "360796020",
            "telephone_number": "334-670-6726",
            "fax_number": "334-670-6731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E WATTS ST",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363302511",
            "telephone_number": "334-393-5437",
            "fax_number": "334-489-4438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2019-02-21",
        "status": "A",
        "authorized_official_last_name": "LITTLE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-670-6726",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630006018",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Enterprise Children's Center & Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Enterprise, AL

Sources for this page

Verify at the official NPI Registry.