NPIMap

Individual provider Active NPI

Audrey C. Guthrie, PA-C

  • Pediatric Adolescent Medicine Physician
  • Brewton, AL
National Provider Identifier
1912988551
Registry record updated Apr 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
PA-395 Issued in AL
Practice address
1205 Belleville Ave
Brewton, AL 36426-1304
Phone
(251) 867-3608
Fax
(251) 867-3610
NPI assigned
Nov 10, 2005
Last updated
Apr 29, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X PA-395 AL Primary

Addresses

Primary practice location

1205 Belleville Ave
Brewton, AL 36426-1304

Mailing address

1205 Belleville Ave
Brewton, AL 36426-1304
Phone (251) 867-3608

Other identifiers 2

IdentifierTypeStateIssuer
009969685MedicaidAL
51524734GUTOtherALBC/BS OF ALABAMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121101000518 AL Practitioner - Physician Assistant 5698925469 Reassigns benefits to 2 organizations
I20180117001436 TX Practitioner - Physician Assistant 5698925469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poarch Band of Creek IndiansGroup PAC ID 9830188085, 12 clinicians

Practice addresses (Care Compare)

5811 Jack Springs Rd
Atmore, AL 36502-5025

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-395ALMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
D W McMillan Memorial Hospital CurrentSince Sep 23, 2012 Accepting new patients
Escambia County Health Care Authority CurrentSince Dec 1, 2012 Accepting new patients

Locations

1301 Belleville Ave
Brewton, AL 36426
Phone (251) 809-8439

174 Highway 113
Flomaton, AL 36441
Phone (251) 296-2456

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304035200000",
    "number": "1912988551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 BELLEVILLE AVE",
            "city": "BREWTON",
            "state": "AL",
            "postal_code": "364261304",
            "telephone_number": "251-867-3608",
            "fax_number": "251-867-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 BELLEVILLE AVE",
            "city": "BREWTON",
            "state": "AL",
            "postal_code": "364261304",
            "telephone_number": "251-867-3608",
            "fax_number": "251-867-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTHRIE",
        "first_name": "AUDREY",
        "middle_name": "C.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-10",
        "last_updated": "2011-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "AL",
            "license": "PA-395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009969685",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF ALABAMA",
            "identifier": "51524734GUT",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brewton, AL

Sources for this page

Verify at the official NPI Registry.