NPIMap

Organization Active NPI

Lister Health Care Corporation

Doing business as Ardmore Clinic

  • Family Medicine Physician
  • Ardmore, AL
National Provider Identifier
1922044494
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LISTER HEALTH CARE CORPORATION
Doing business as
Ardmore Clinic
Practice address
30320 Al Highway 53 Ste B&C
Ardmore, AL 35739-8766
Phone
(256) 423-4800
Fax
(256) 423-8448
NPI assigned
Jun 21, 2006
Last updated
Oct 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

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

Authorized official

Name
Krista Chase
Title
Credentialing Agent
Phone
(256) 767-7494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

30320 Al Highway 53 Ste B&C
Ardmore, AL 35739-8766

Mailing address

PO Box 298
Florence, AL 35631-0298
Phone (256) 767-7494

Other names 1

  • Ardmore Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211111002469 AL Part B Supplier - Clinic/Group Practice 5395646202 Receives reassigned benefits from 15 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ardmore, AL; Calera, AL; Muscle Shoals, AL

Other NPIs on the same Medicare enrollment 3

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
01D1056064Ardmore Clinic30320 Al Hwy 53, Suite C, Ardmore, AL 35739Certificate of waiverJul 4, 2028

National Provider Directory

National Provider Directory

Locations

30320 AL Highway 53
Ste Bc
Ardmore, AL 35739
Phone (256) 423-4800

30320 AL Highway 53
Ste B
Ardmore, AL 35739
Phone (256) 423-4800

30320 AL Highway 53
Ste B1C
Ardmore, AL 35739

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601942400000",
    "number": "1922044494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 298",
            "city": "FLORENCE",
            "state": "AL",
            "postal_code": "356310298",
            "telephone_number": "256-767-7494",
            "fax_number": "256-760-8432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30320 AL HIGHWAY 53 STE B&C",
            "city": "ARDMORE",
            "state": "AL",
            "postal_code": "357398766",
            "telephone_number": "256-423-4800",
            "fax_number": "256-423-8448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISTER HEALTH CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "CHASE",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_title_or_position": "CREDENTIALING AGENT",
        "authorized_official_telephone_number": "256-767-7494"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ardmore Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ardmore Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ardmore, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; 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.