NPIMap

Organization Active NPI

Practice-Monroeville Inc

Doing business as Primary Care Center of Monroeville

  • Clinic/Center
  • Monroeville, AL
National Provider Identifier
1972606531
Registry record updated Nov 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PRACTICE-MONROEVILLE INC
Doing business as
Primary Care Center of Monroeville
Practice address
1075 Drewry Rd
Suite B
Monroeville, AL 36460
Phone
(251) 575-5988
Fax
(251) 575-5970
NPI assigned
Sep 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2022

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

Authorized official

Name
Jackie Wright
Title
Office Manager
Phone
(251) 575-5988

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1075 Drewry Rd
Suite B
Monroeville, AL 36460

Mailing address

1075 Drewry Rd
Suite B
Monroeville, AL 36460
Phone (251) 575-5988

Other identifiers 1

IdentifierTypeStateIssuer
529911320MedicaidAL

Other names 1

  • Primary Care Center of Monroeville Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061031000345 AL Part B Supplier - Clinic/Group Practice 2860499019 Receives reassigned benefits from 3 practitioners
Practice locations: Monroeville, AL
O20151221000659 AL Part A Provider - Rural Health Clinic 2860499019 Practice locations: Monroeville, AL

Rural health clinic certification: CCN 018922

Legal name
PRACTICE-MONROEVILLE INC.
Doing business as
PRIMARY CARE CENTER OF MONROEVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 21, 2016
Last certification
Jun 1, 2023
Ownership / control type
1C
Organization structure
CorporationProprietary
Incorporated
Sep 27, 2006 in AL
Enrollment address
1075 Drewry Road
Monroeville, AL 36460-2840

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
01D1054292Primary Care Center of Monroeville1075 Drewry Rd Suite B, Monroeville, AL 36460Certificate of waiverMay 15, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Angela a Powell Individual 5% Or Greater Direct Ownership Interest Sep 27, 2006 100%
Corporate OfficerPresident/VP/ Secretary Sep 27, 2006 100%
W-2 Managing EmployeeManaging Employee Sep 27, 2006

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Angela A Powell, MD
    • Family Medicine Physician
    • Monroeville, AL
    • NPI 1265478663

    5% Or Greater Direct Ownership Interest, Corporate Officer, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668556800000",
    "number": "1972606531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 DREWRY RD",
            "address_2": "SUITE B",
            "city": "MONROEVILLE",
            "state": "AL",
            "postal_code": "36460",
            "telephone_number": "251-575-5988",
            "fax_number": "251-575-5970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 DREWRY RD",
            "address_2": "SUITE B",
            "city": "MONROEVILLE",
            "state": "AL",
            "postal_code": "36460",
            "telephone_number": "251-575-5988",
            "fax_number": "251-575-5970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRACTICE-MONROEVILLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "251-575-5988"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529911320",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primary Care Center of Monroeville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroeville, AL

Sources for this page

Verify at the official NPI Registry.