Larry Wayne Wade, MD
Individual provider Active NPI Internal Medicine Physician · Fultondale, AL
NPI 1922094085 · NPPES record last updated Jun 16, 2010
Key facts
- NPI
- 1922094085
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 00017461 (AL)
- Practice address
- 2619 Decatur Hwy
Fultondale, AL 35068-1723 - Phone
- (205) 841-9898
- Fax
- (205) 841-9880
- NPI assigned
- Sep 23, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051010000834 | AL | Practitioner - Internal Medicine |
5294750170 | Reassigns benefits to 1 organization |
| I20101119000810 | AL | Practitioner - Internal Medicine |
5294750170 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00017461 | AL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paragon Contracting Services LLC | Current |
Accepting new patients | |
| Carraway Emergency Physicians, LLC | Past | Accepting new patients | |
| Physicians Emergency Services, LLC | Past | Accepting new patients | |
| North Jefferson Internal Medicine | Internal Medicine | Past | Accepting new patients |
| Premier Medical | Past | Accepting new patients | |
| Frances Mahon Deaconess Hospital | Past | Accepting new patients |
Locations
810 Saint Vincents Dr
Birmingham, AL 35205
Phone (205) 930-2456
50 Medical Park Dr E
Birmingham, AL 35235
Phone (205) 838-3000
1515 6th Ave S
Birmingham, AL 35233
Phone (205) 930-3200
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1262
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 00017461 | AL | Yes |
Addresses
Primary practice location
2619 Decatur Hwy
Fultondale, AL 35068-1723
Mailing address
2619 Decatur Hwy
Fultondale, AL 35068-1723
Phone (205) 841-9898
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 051503805 | Medicaid | AL |
Other providers in Fultondale, AL
- Therapy South LLC Fultondale
- TPS, LLC
- Victor Tran
- Jennifer Amarachi Ukeje
- Hannah Vorenkamp
- Walgreen Co
- Andrea White
- William and Mary Pharmacy
- Liza Craven Williams
- Lucille Smith Wood
All providers in Fultondale, AL · Internal Medicine Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.